A workflow redesign for The Oregon Clinic
Role: Referral Coordinator
Challenge Accepted: Took over the chaotic infusion therapy department.
Issues: Denied claims, financial losses, stressed-out patients.
Why Me: Known for problem-solving, organization, and communication skills.
Let's dive into the journey of turning chaos into a well-oiled machine!
The Challenge
In my role as a referral coordinator at The Oregon Clinic, an exciting opportunity came my way. Tasked by management to take charge of the infusion therapy department, I stepped into a realm of disorganization and chaos. The challenges were evident—denied claims, financial strain, and, more importantly, stressed-out patients relying on us for improved quality of life. The decision to appoint me as the lead spoke to my reputation as a problem solver with strong organizational and communication skills. Eager for the challenge, I embarked on a mission to bring order to chaos and enhance the patient experience.
The Journey
Deep Dive into Infusion Therapy: To pave the way for change, my initial stride involved immersing myself in the intricacies of infusion therapy. At The Oregon Clinic, this critical treatment involves administering medications like Stelara or Remicade to patients grappling with chronic irritable bowel diseases such as ulcerative colitis or Crohn's disease. The therapy, while not a cure, significantly alleviates the often excruciating signs and symptoms of these conditions. Moreover, the financial burden on patients for high-dollar treatments like Remicade, ranging from $1,300 to $2,500 per dose, adds another layer of complexity. My role? Ensuring the seamless authorization and payment for each infusion.
Crafting Narratives Amidst Jargon: To navigate the intricate web of insurance intricacies, I became a storyteller of sorts. Utilizing diagnosis codes and doctor notes, I artfully communicated with insurance companies, deciphering their unique jargon and understanding their authorization expectations. A delicate dance ensued, as I balanced communication between providers, patients, and insurers—each with their distinct communication styles.
Empathy as a Catalyst: Delving deeper into the world of patients grappling with chronic illnesses like IBD, I gained profound empathy. Understanding the financial strain coupled with the physical and emotional toll of their conditions fueled my determination to find solutions. It was about more than just authorizations; it was about instilling confidence in our patients that they were in capable hands.
Spotting Red Flags: The journey to improvement led me to collaborate with nursing staff and the billing department, dissecting the existing workflow. What emerged were glaring issues:
No Tracking System: The absence of a robust tracking system led to inefficiencies.
Communication Gaps: A lack of communication channels hindered the flow of vital information.
Absence of Standards: No training material, no standardized processes, and no established rules left room for confusion and disputes.
Armed with these insights, the path forward became clear: a comprehensive overhaul addressing these red flags was necessary to usher in a new era of efficiency and patient-centric care.
Optimizing the Workflow
Authorization Audit and Tracking System: My first strategic move involved conducting a thorough audit of all active authorizations. Implementing a meticulous tracking system with follow-up dates drastically reduced investigation time, amplifying efficiency across the board.
Boosting Confidence and Credibility: The impact was immediate. I could swiftly address doctors' and patients' inquiries about specific authorizations, instilling confidence in the precision of our work and enhancing the overall credibility of my department.
Figma Design for Centricity EMR: Leveraging Figma, I crafted a visual representation of the Centricity Electronic Medical Records (EMR) software, refining its interface for clarity. The redesigned layout, akin to an email service, focuses on the most crucial aspect for referral coordinators—chronologically sorted subjects, allowing swift identification of follow-up dates.
Enhanced User Interface: Navigating through Centricity, the top center now denotes the clinic under scrutiny. The subject, serving as a chronological marker, stands out, especially for referral coordinators managing multiple authorizations. An intuitive layout resembling an email service expedites the identification of pending follow-ups.
Detailed Content at a Glance: Selecting a specific authorization reveals detailed content below, accompanied by a section for more intricate notes. In the hustle of a heavy workload, leaving a comprehensive narrative becomes pivotal for effective communication, ensuring clarity when the follow-up date looms.
Identifying New Authorizations: For a seamless workflow, I incorporated a visual cue—absence of a follow-up date indicates a new authorization requiring immediate attention from the clinic.
Strategic Communication: With a streamlined workflow in place, the next step was aligning the clinics. A detailed project summary, sent to each department head, included:
A succinct overview of the problem and proposed solution
A breakdown of the new tracking method
Clear expectations and turnaround time for each authorization
Comprehensive guides and training materials to facilitate seamless adoption of the revamped process.
This strategic communication ensured that everyone involved was on the same page, fostering cohesion and uniformity across the three clinics.
The Results
Immediate results revealed a noteworthy 37% reduction in both denied claims and missed authorizations. This positive trend continued, culminating in an impressive 81% decrease over a six-month span.
Beyond the evident financial improvements, The Oregon Clinic experienced a surge in insurance payments, reflecting the effectiveness of the streamlined authorization process. Simultaneously, overall patient satisfaction levels soared, underlining the tangible and holistic success achieved through this initiative.
