Magellan Health Announces Deployment of Automated Authorization Solution

At Magellan Health we always look to bring our A-Game. When you work at Magellan Health you can be assured that we will bring our A-Game and in turn we will ask you to bring your A-Game to the work you do everyday. Recently Magellan Health 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. This is just one way we are bringing our A-Game. 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.

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Heidi Chapeau

Heidi Chapeau is the Recruitment Marketing Director at Magellan Health.