BACKGROUND
Austin Heart is a prominent cardiology group affiliated with St. David’s Heart and Vascular in HCA’s Central and West Texas Division. The group is made up of 55 providers and manages 28 locations, including their main site at the Heart Hospital of Austin and outreach clinics across central Texas.
CHALLENGE
As Austin Heart rapidly expanded between 2017 and 2020, centralizing essential patient access processes like prior authorization and referral coordination proved challenging due to the increasing complexity of their hub-and-spoke diagnostic and procedural model. The group explored re-engineering and streamlining patient access processes with Infinx due to:
- Decentralized Prior Authorization Process: Each office was responsible for obtaining prior authorizations, leading to duplicated efforts and inefficiencies across multiple team members.
- Interruption/Delays in Patient Care: Staffing shortages made it difficult to manage the volume of cases, leading to delays in authorizations, scheduling delays and a decrease in patient satisfaction.
- High Denial Rates: Patient cancellations and last-minute changes in appointment locations caused authorization mismatches, resulting in high denial rates and revenue cycle inefficiencies.
SOLUTION
Implementation of Centralized, Tech-Enabled Prior Authorization
Initial work began with the Infinx Prior Authorization tool to improve operations and enhance scalability. During onboarding and final implementation, Austin Heart’s clinic staff collaborated closely with the Infinx team, enabling the clinic to repurpose vital staff for more complex, patient-centered tasks.
By centralizing authorization processes and significantly reducing the burden on individual offices, Infinx allowed for faster scheduling of appointments for important patient diagnostics.
AI-enhanced software and customized Robotic Process Automation (RPA), was used by the Infinx team to streamline the prior authorization workflow and ensure timely completion. For instance, AI algorithms were used to predict the likelihood of authorization approval, automating routine decisions and flagging complex cases for Austin Heart’s review.
“The Infinx team has been good about staying in touch with us and course correcting as needed in the early days to present. The partnership has been a great success, and Infinx allows us to manage cases more effectively.”
— Kelli Shifflett, former AVP of Growth and Business Development, HCA Physician Services
A Long-term Partnership for Patient Access Excellence
Austin Heart addressed their challenges by centralizing prior authorization, leveraging advanced technology, and receiving consistent support from Infinx. This partnership improved efficiency, reduced denial rates, enhanced data transport times, and boosted patient care. The success led to the installation of Infinx’s solutions in sister HCA PSG practices across Texas, showcasing a scalable template for emerging markets.
If you are looking to achieve similar results at your organization, contact us at www.infinx.com/request-a-demo.
Are decentralized processes causing delays in patient care and high denial rates at your cardiology practice? Discover how Austin Heart improved efficiency, centralized prior authorizations, and reduced denials with Infinx’s tailored solutions.