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Improving the Linkage to HIV Specialty Care: Referral and Authorization Process Redesign at the AIDS Healthcare Foundation

  • Author(s): Parks, Ashley Victoria
  • Advisor(s): Inkelas, Moira
  • et al.
Abstract

In September 2014 leadership of the AIDS Healthcare Foundation commissioned the formation of a multidisciplinary process improvement team to improve the timeliness, overall satisfaction, and specialty visit completion rate for the AHF California Managed Care Plans’ outpatient referral and authorization processes. In addition to making targeted improvements in timeliness and satisfaction, the team was also tasked with developing a long-term monitoring strategy to support future improvement in the processing of referrals and authorizations. The Referral Improvement Task Force reviewed best practice models, created and analyzed performance data including turnaround time and patient grievances, and conducted a series of key informant interviews with staff and providers in order to develop and implement targeted strategies. Utilization Management staff in the Managed Care Division assumed additional responsibility for referral and authorization processing, allowing for the division to completely own and streamline the referral and authorization processes for California managed care patients thus addressing delays in the referral and authorization process. Through this process improvement effort, AHF drastically reduced the processing time for outpatient specialty care referrals from an average of 12.5 days in the pre-intervention period, to an average turnaround time of 1.5 days during the final phase of the process improvement. Both the mean number of days required to generate an authorization and the mean number of days from physician order to specialty visit decreased significantly with ANOVA and t-test p-values below .01. This reduction was accomplished through the implementation of several process improvement efforts, including a staff re-organization and process redesign as well as the development of opportunities for referral and care coordination within the electronic medical record.

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