Sharpening coordinated care processes

Lean and Six Sigma tools improve medical authorization

By Brandon Deihl

Eliminating waste and process variation certainly have their place in manufacturing, but lean and Six Sigma have value elsewhere – including managed care.

The case study described in this article involves a coordinated care plan that primarily focuses on the Medicare Advantage market. This operation differentiates itself from other coordinated care plans by focusing its resources around the physicians in its network, which allows the physicians to manage the care of the members in the best possible fashion. Management gave the lean and Six Sigma team an assignment: “Evaluate local and regional markets to identify areas to improve the prior authorization process so that inefficiencies can be reduced or eliminated. The evaluation will include staff level competency, process and systems analysis and recommendations for improvement.”