Utilization Review is a critical process that can play a significant role in ensuring the efficient and effective use of resources while maintaining high-quality patient care. With a deep commitment to refining the utilization review process for almost 20 years, EK Health Services Inc. has focused heavily on developing a clinically sound and operationally excellent product backed by innovative technology and an exceptionally strong clinical team.
EK Health's President & COO, Kerri Wilson, emphasizes their journey: "We became a Utilization Review Organization (URO) because we foresaw and experienced the burden of the process. In response, we built technology solutions with our sister company, DataCare, to remove challenges for the adjuster, nurse, provider, and payor.”...
Where Creativity and Innovation Meet
At EK Health, Utilization Review is more than just a process; it intricately synchronizes systems with evidence-based guidelines and regulations. The company's comprehensive approach molds Case Management, Bill Review, and Utilization Review together, creating masterpieces of streamlined efficiency. Wilson emphasizes, "We knew that clinicians needed to focus on the clinical over aggressive timelines, and we knew we would need creative solutions. We then tirelessly innovated to combine technological precision with human expertise to guide the right treatment decisions."
Quality Reviews for Necessary Outcomes
To consistently deliver a high level of expertise, EK Health partners with qualified Independent Reviewers for objective, quality reviews for medically necessary outcomes. This commitment is reflected in EK Health’s approach to direct communication with prescribing physicians throughout the process, ensuring decisions are consistently made with the necessary information to render strong decisions that are formed in the best interest of the patient. “The health care professionals and physician reviewers we work with tirelessly strive to ensure that decisions are thorough, while the purpose of the Utilization Review process is strongly upheld, especially in jurisdictions with stringent requirements,” Wilson stated.
Metrics That Paint a Picture
While it is easy for EK Health to brush colorful narratives on a page about their program, it is much harder to obtain the stamp of URAC excellence - and yet, they have done that time and time again. With gold-standard URAC accreditations of 100% for the last four audits spanning over a decade, DWC audits of 100%, and impressive turnaround times, they paint a picture of effectiveness that is hard to match.
In addition, their utilization review process is a symphony of efficiency. With impressively low appeal rates and a 99.8% timeliness rate based on statutory requirements in all jurisdictions, EK Health streamlines the entire process, delivering unparalleled results. Wilson adds, "We are proud to state that our appeal rate for all formal UR RFAs is a remarkable 2.5%."
An Ongoing Masterpiece
EK Health strives to leave the industry with a legacy of clinical excellence, efficiency, and cost savings. EK Health's client and provider testimonials only further underscore this commitment. One occupational medicine physician expressed, "We are grateful for programs that move to EK Health, their service is exceptional." While the utilization review process can be intricate and challenging, EK Health continues to redefine it, hoping to leave meaningful change across the industry for years to come.