Utilization review (UR) organizations need to coordinate the efforts of highly skilled professionals on a tight timetable. This makes modern technology a requirement for a top-performing team.
According to Dr. Doug Benner, who led Kaiserʼs occupational health services for 30 years and now serves as medical business product development officer at EK Health, the California-based, URAC-certified utilization review organization, “The DataCare platform provides a more efficient, complete, and accurate utilization review process that saves time, lowers costs, and insures that the right decision is made quickly.”

Here are six ways that DataCareʼs advanced technology platform is helping organizations improve treatment, while lowering medical and program costs – and six ways to evaluate whether your platform stacks up:

• REAL-TIME REPORTING. Managers use real-time reports to anticipate and clear bottlenecks and to balance workflows. Operations Managers can start their day by checking the number of documents in the intake queue and the number of cases pending nurse assignment, to make sure their team gets off to a fast start. At the same time, the head of the UR medical team reviews a real-time status report that shows all cases by nurse and by stage. By monitoring these key reports throughout the day, they can identify potential problems and quickly reassign cases. The result is that treating physicians receive well-documented authorizations or denials through DataCare’s advanced software platform in less than 2.5 calendar days, significantly better than the 5.0 days required by the state of California.
• ACCURATE STAFFING MODELS. Internal time stamping of all activities allows users to build an accurate model. DataCare clients pull reports that answer questions like “How many minutes does it take for administrative staff to set up a case? How long does it take nurses to handle prospective, retrospective, and concurrent reviews?” The answers to these questions enable them to develop models that ensure enough staff to provide effective service but no more!
• IMPROVED QUALITY. Industry-wide, as many as 20% of UR denials result from insufficient information. This delays treatment, increases medical costs, and takes valuable nurse and physician time. DataCare’s quality assurance component helps identify when incomplete or inaccurate information is received from providers, adjusters, and/or intake staff.
• PROVIDER ANALYSIS. For years, MPN physicians who use DataCare have been able to account for less than 1% of our denials; this has significantly contributed to our low medical costs.
• DATA MINING. DataCare’s system insures consistent and proper application of evidence-based guidelines. Several of our clients and their teams are able to quickly filter cases by diagnosis and treatment codes and then dig down into the medical file to insure that different reviewers are handling cases consistently. For example, all spinal surgery cases can be pulled and checked to see which treatments were authorized or denied and which guidelines were cited.
• ELIMINATE SILOS. According to the Director of Disability at a Fortune 100 self-insured DataCare client, “Improvements in our UR platform set the stage for a series of changes in our workersʼ compensation system which have contributed to holding medical costs constant over the last three years. Because the DataCare system enables us to document treatments using treatment codes, we are able to link the UR system with bill review and automatically verify medical bills against treatment authorizations and denials. This additional layer of verification is lowering medical expenses by 14% to 20% more than when our bill review and UR were not integrated.”

DataCareʼs advanced technology is providing many managers with the ability to identify workflow problems before they impact timely medical care or create unnecessary medical expenses.