Prior authorization tool for images to get test in Hawaii

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Two vendor organizations are working to test technology that will place clinical decision support within electronic health records to enable proper choice of radiological procedures.

The ability to give physicians access to CDS within their regular workflows is crucial in advance of a new government initiative that will call for physicians to consult clinical guidelines before ordering certain types of advanced imaging procedures for Medicare beneficiaries.

The federal program will require providers to consult clinical guidelines before ordering eight different types of procedures, then including a code with the imaging order. Outpatient providers that perform the procedures may have payments at risk if the codes aren’t included after 2020. Questions have been raised about how CDS consultations can be done within clinicians’ workflow.

In this project, Hawaii Pacific Health will conduct a test of an application called DecisionPoint, a project of Magellan Health and Stanson Health, the CDS technology division of Premier.

Magellan’s DecisionPoint project will provide prior authorization capabilities at the point of care, powered by Premier’s CDS technology, with the aim of automating the prior authorization process within the EHR and physicians’ workflow.

As part of the collaborative initiative, Hawaii Pacific Health and other provider groups will participate in a pilot of the system. HPH is one of the largest healthcare providers in the state, with four major medical centers and more than 70 locations statewide.

The pilot will be administered though Hawaii Health Partners, HPH’s accountable care organization. The pilot will leverage Magellan’s clinical guidelines for the top-utilized advanced imaging studies, as well as Magellan’s full panel of clinical experts.

“Being one of the first to implement an enhanced CDS system is part of our goal to be the leader in healthcare transformation in Hawaii. It is our hope that this system will assist providers in delivering the most appropriate care, help streamline care delivery and ease provider workflow,” says Gerard Livaudais, MD, vice president of Hawaii Health Partners.

“Our approach to prior authorization will help ensure that patients receive real-time authorization decisions and evidence-based care whenever possible,” says Scott Weingarten, MD, chief executive officer of Stanson Health. “We believe that this approach, using machine learning and AI algorithms, should improve patient experience, provider satisfaction, and the affordability of care.”

DecisionPoint is initially focused on advanced imaging studies. It is expected to be available to additional providers toward the end of the year and will expand to additional product lines in the future.

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