Adam Basua, of Community Memorial Health System, breaks down his process for optimizing the complexities of referrals and prior authorizations
In a recent interview, Adam Basua, Community Memorial’s Healthcare Management Leader, shares how he approached the challenges of optimizing referrals and prior authorizations for his team, and offers advice for those navigating the complexities of both.
When Adam first joined CMHS, he knew they had a significant problem. They faced a lack of structure across their 15 locations with everyone, he describes, “doing their own thing”. Without a centralized system, the lack of visibility made it challenging to identify, much less isolate, problematic processes. “So, who suffered? The patients,” Adam says with a heaviness.
Like so many others, Covid exposed weaknesses that couldn’t be ignored any longer; in many ways, Covid became the catalyst for change. With staff out sick on top of ongoing shortages, CMHS needed visibility across their clinics. Leaning on his background in IT, Adam sought a centralized, technology-based solution that would provide them with the automation and visibility they needed. After onboarding VALER, CMHS saw a night and day difference. They finally had an overview of productivity across their multiple locations, as well as the ability to measure how much energy employees were putting into their roles. “All these intricate parts of the process can now be documented, and can be easily gathered with data,” Adam says.
When asked what else has changed since CMHS brought VALER on board, Adam boasts cutting their referral submission time from 15 days to four, three, even two days. “Unheard of, we weren’t even close to this,” he remarks. That metric alone translates directly to better patient care. “Patients love the response time,” Adam explains and admits with a chuckle that their problem now is that “our doctors are spoiled.”
You might expect that these wins would be Adam’s favorite aspects of VALER, but when asked he smiles and says, “You’re going to laugh, but it’s just working with you.” Adam goes on to explain that his relationship with VALER isn’t like that of a typical vendor. “I feel like VALER is part of our organization,” he says. This is no accident; VALER intentionally cultivates the attributes of a partnership with their clients. In the words of Steve Kim, Voluware’s CEO (VALER’s parent company), “We consider ourselves part of the team. We are on the same team.”
Before the interview wraps up, Adam shares his advice for those looking to implement a software-based solution to their referral or prior authorization process. He poses three core questions you should ask of any application you’re considering:
- Can the software talk to insurance portals? This is a must to removing the burden of manual processes.
- How well does the software integrate with your EHR? This is a critical component for streamlining.
- Can it grab productivity data that allows you to hold staff accountable, reward high achievers, and properly assess staffing needs?
The interview ends with Adam’s final statement, “If you take VALER away from me, I’ll quit.” We think he’s joking, but then again, maybe not. You can watch the full interview and other VALER Voices interviews HERE.