EmblemHealth cuts red tape and revamps by using tech and data

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To cut red tape, please members and lower costs, EmblemHealth is cutting the number of medical procedures in half for which it will require prior authorization.

Karen Ignagni, president and CEO of New York -based EmblemHealth, says the reduction in prior authorization requirements is part of an overall transformation of the health plan’s operations. "Through careful analysis of our data, we identified services that almost always get approved,” she says. “Looking forward, we will continue to review our data with the goal of finding additional ways to reduce red tape and simplify administrative procedures."

The procedures EmblemHealth will now cover without the need for prior authorization includes services provided in the hospital setting, including cardiac and vascular procedures, gallbladder removal and treatment of glaucoma, according to Ignagni. The cutting of red tape for these procedures helps to ensure the plan’s 3.1 million members receive needed care quickly and efficiently, she says.

EmblemHealth’s decision to cut some of its prior authorization requirements was driven by “rigorous data analysis” and was based on “nationally established best practices” that ensuring high-quality, affordable care, the health plan said. EmblemHealth also hopes the new changes will be useful to providers in EmblemHealth’s network, who will have more time to spend on their patients. The move is “an integral part” of what EmblemHealth calls an ongoing effort to use technology and information to work in partnership with its providers to provide the best care.

The reduction in prior authorization requirements on January 1 follows the company’s November launch of a new website and video statements. EmblemHealth’s November upgrade of its website, available in both English and Spanish, was based on insights it gained from more than 300 current and prospective plan members, when asked what they consider to be a “best-in-class, user-friendly experience,” the health plan said.

The website’s new features include a home page geared towards members’ key questions; customization to help various audiences more quickly find the information they are looking for; and a smart search feature that suggests the most popular search items. The website also uses geotargeting to collect users’ location information to suggest relevant healthcare plans and nearby neighborhood care locations.

In addition to the website overhaul, EmblemHealth added personalized video statements through its member portal that provide account summaries, billing details and benefit explanations. EmblemHealth executives said the portal is designed to enhance member experience, while reducing administrative overhead.

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