Innovative MCO engages hospitals to improve inpatient authorization timelines and reduce burdens on providers and members
DAYTON, Ohio, March 12, 2024 /PRNewswire-PRWeb/ -- MCG Health, part of the Hearst Health network and an industry leader in technology-enabled, evidence-based guidance, has named CareSource a recipient of its 2023 Richard L. Doyle Award for Innovation and Leadership in Healthcare. The nonprofit managed care organization (MCO) was recognized for successfully collaborating with hospitals to transform the inpatient authorization process.
CareSource's winning initiative involved partnering with Cleveland Clinic and University Hospitals to improve turnaround times for authorization responses and reduce administrative burden.
CareSource Executive Vice President and Chief Medical Officer, Dr. David Williams, said, "This award from MCG is a true acknowledgment of CareSource's commitment to create value for our state partners, to reduce administrative burden for all providers, and to ensure members receive timely, medically necessary care."
MCG Health President and CEO, Jon Shreve said, "We congratulate CareSource on receiving the Doyle Award as it reflects their collaborative nature and technological determination. By embracing this path, they are improving the lives of their members and showing other payers and providers how to work together for a successful future."
CareSource became one of the first adopters of MCG Cite for Collaborative Care, an interoperability solution that connects payers and providers via their respective medical management and electronic health record (EHR) platforms. This process enables both the payer and provider to avoid the tedious fax communication process and allows data interaction to happen in near real-time. This implementation reduced the time and effort for inpatient authorizations by six to seven minutes per review.
In addition to MCG Cite for Collaborative Care, CareSource continues to drive provider adoption through its provider portal that leverages MCG Cite AutoAuth technology. CareSource processes 73% of eligible authorization types through its provider portal; because of MCG Cite AutoAuth technology, CareSource can respond to 20-30% of a provider's requests during the provider's initial interaction with the CareSource Portal. This process led to faster and less burdensome experiences for providers and timelier treatment for CareSource's members.
The collaboration between MCG and CareSource effectively expedited members' medical care requests by streamlining decision-making between CareSource and the provider and ensuring the initial collection of all necessary medical information. Additionally, for cases received through Cite for Collaborative Care, there has been a 5.5% increase in first-pass determinations leading to a reduction in Medical Director referrals for review.
The second provider CareSource implemented with, University Hospitals, reported a 60% reduction in faxes from CareSource, which allowed hospital staff to focus on other time-critical tasks and individual patient needs. This hospital reported saving 20 hours per week due to the significant reduction in administrative burden.
Christopher Tarr, CareSource's Director of Clinical Operations and Clinical Systems said, "Providers are excited about the increase in near real-time speed of communication and wish more payers would implement this fast, bidirectional exchange of information."
The Richard L. Doyle Award for Innovation and Leadership in Healthcare is presented annually to two organizations — one payer and one provider — that use MCG solutions in exceptional ways to achieve improved patient care, reduce unnecessary costs, and optimize efficiency.
About CareSource
CareSource is a nonprofit, nationally recognized managed care organization with over 2.3 million members. CareSource administers one of the largest Medicaid managed care plans in the U.S. The organization offers health insurance, including Medicaid, Health Insurance Marketplace, and Medicare products. As a mission-driven organization, CareSource is transforming health care with innovative programs that address the social determinants of health, health equity, prevention and access to care.
About MCG Health
MCG, part of the Hearst Health network, provides unbiased clinical guidance that gives healthcare organizations confidence in delivering patient-centered care. MCG's artificial intelligence and technology, infused with clinical expertise, enable its clients to prioritize and simplify their work. MCG's world-class customer service ensures that clients maximize the benefits of licensing MCG solutions – demonstrating improved clinical and financial outcomes. For more information visit http://www.mcg.com.
About Hearst Health
The mission of Hearst Health is to help guide the most important care moments by delivering vital information into the hands of everyone who touches a person's health journey. Care guidance from Hearst Health reaches the majority of people in the U.S. The Hearst Health network includes FDB (First Databank), Zynx Health, MCG, Homecare Homebase, and MHK (formerly MedHOK). Hearst also holds a minority interest in the precision medicine and oncology analytics company Aster Insights. Follow Hearst Health on Twitter @HearstHealth and LinkedIn @Hearst-Health.
Media Contact
Arri Burgess, MCG Health, (206) 389-5405, [email protected], https://www.mcg.com/
SOURCE MCG Health
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