Magellan Health, Inc. announced a collaboration with Stanson Health, Premier, Inc.’s clinical decision support (CDS) technology division, to deploy an industry-leading automated prior authorization (PA) solution at the point of care. Magellan’s enhanced CDS Tool, DecisionPoint, which will be powered by Premier’s CDS technology, supports true automation of the prior authorization process within the electronic health record (EHR) and physician workflow.
DecisionPoint is built with Magellan Healthcare’s Advanced Imaging Management program clinical guidelines and Premier’s award-winning technology platform. The tool will provide clinical guidelines for determining the medical necessity of certain imaging procedures to inform providers and enable authorization determinations in real time, improving efficiency of the overall PA process for providers and health plans, while also enhancing the member experience and maintaining clinical integrity.
“As a national leader in digital and clinical innovation, we continuously focus on building more provider-friendly approaches that reduce inefficiencies throughout the healthcare delivery system,” said Gus Giraldo, Magellan Healthcare’s president of behavioral and specialty health. “Our collaboration with Premier is an example of our ongoing efforts to advance the industry commitment to automate prior authorization for better care delivery. With DecisionPoint, providers and payers can experience greater value through more effective processes combined with Magellan’s high level of clinical intensity.”
As part of the collaborative initiative, Hawai‘i Pacific Health (HPH) and other provider groups will participate in a pilot of Magellan’s guidelines embedded in the system. HPH is one of the largest healthcare providers in Hawai‘i, with four major medical centers and more than 70 locations statewide. The pilot will be administered though Hawai‘i Health Partners, HPH’s Accountable Care Organization (ACO). 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 Hawai‘i. It is our hope that this system will assist providers in delivering the most appropriate care, help streamline care delivery and ease provider workflow,” said Gerard Livaudais, M.D., vice president of Hawai‘i Health Partners. “This will ultimately enhance the patient experience, as well as the quality of care that our patients receive.”
The healthcare industry is in the midst of a significant paradigm shift as it transitions from fee-for service models to value-based care. As a technology-augmented service backed by the support of providers, DecisionPoint is designed to minimize the industry’s challenges by fully integrating with EHRs at the point of care to enable more timely, automated PAs.
“We look forward to working with Magellan and Hawai‘i Pacific Health to pilot this initiative,” said Scott Weingarten, M.D., chief executive officer of Stanson Health, a Premier Company. “Our approach to prior authorization will help ensure that patients receive real-time authorization decisions and evidence-based care whenever possible. We believe that this approach, using machine learning and AI algorithms, should improve patient experience, provider satisfaction, and the affordability of care.”
DecisionPoint, initially focused on Magellan’s advanced imaging studies, is expected to be available to additional providers in the fourth quarter of 2019 and will expand to additional product lines in the future. This will include further clinical decision-making capabilities to assist physicians and patients in optimizing the care plan. For more information, please visit MagellanHealthcare.com or email ProviderSolutions@MagellanHealth.com.
About Premier, Inc.
Premier, Inc. is a leading healthcare improvement company, uniting an alliance of more than 4,000 U.S. hospitals and health systems and approximately 165,000 other providers and organizations to transform healthcare. With integrated data and analytics, collaboratives, supply chain solutions, and consulting and other services, Premier enables better care and outcomes at a lower cost. Premier plays a critical role in the rapidly evolving healthcare industry, collaborating with members to co-develop long-term innovations that reinvent and improve the way care is delivered to patients nationwide. Headquartered in Charlotte, N.C., Premier is passionate about transforming American healthcare. Please visit Premier’s news and investor sites on www.premierinc.com
About Magellan Health: Magellan Health, Inc., a Fortune 500 company, is a leader in managing the fastest growing, most complex areas of health, including special populations, complete pharmacy benefits and other specialty areas of healthcare. Magellan supports innovative ways of accessing better health through technology, while remaining focused on the critical personal relationships that are necessary to achieve a healthy, vibrant life. Magellan’s customers include health plans and other managed care organizations, employers, labor unions, various military and governmental agencies and third-party administrators. For more information, visit MagellanHealth.com.
About Hawai‘i Pacific Health: Hawai‘i Pacific Health is a not-for-profit health care system with over 70 locations statewide including medical centers, clinics, physicians and other caregivers serving Hawai‘i and the Pacific Region with high quality, compassionate care. It’s four medical centers—Kapi‘olani Pali Momi, Straub and Wilcox—specialize in innovative programs in women’s health, pediatric care, cardiovascular services, cancer care, bone and joint services and more. Hawai’i Pacific Health is recognized nationally for its excellence in patient care and the use of electronic medical records to improve quality and patient safety.
About Hawai‘i Health Partners: Hawai‘i Health Partners, an affiliate of Hawai‘i Pacific Health, is a physician-led Accountable Care Organization (ACO) with the goal of providing high quality care, increased efficiency and optimal patient health. It is Hawai‘i’s first and only ACO with over 800 physician members.