Welcome to PrevCORE


Are you, your team, and your business facing a problem that threatens your growth and revenue? PrevCORE offers a proactive approach to address process challenges and set new standards for prevention, rather than constant correction. Our goal is to help you gain insight to your problems so you can align your challenges with the best available solution to achieve long-lasting results!

Testimonial


"I recently completed PrevCORE online, and I can confidently say it exceeded my expectations. The course content was not only comprehensive but also presented in a way that made complex concepts easy to understand. The instructor's expertise and engaging teaching style kept me motivated throughout the entire journey. The course platform was user-friendly, was easy to access. "


Jen Helt, ACNO, Adams Memorial Health Hospital

Overview


Albert Einstein once said, "We cannot solve our problems with the same level of thinking that created them." This quote emphasizes the importance of having a clear understanding of a problem or challenge in order to overcome it. Ignoring problems or challenges will not make them go away, so it is essential to acknowledge and discuss them openly. It may not always be necessary to come up with an immediate solution, as sometimes having a better understanding of the problem can lead to a solution. In this course, the basic concepts of background theory are presented to provide that understanding, followed by a simple methodology or process to investigate the problem and find a solution to prevent its recurrence.









Urgent vs. Important

Throughout this course, you will gain a comprehensive understanding of a simple yet powerful methodology that will help you reorient your thinking toward working on making tomorrow better than just merely rectifying today. You will learn how to identify and prioritize important tasks, allocate your time and resources most efficiently, and develop effective strategies to overcome obstacles that may hinder your progress. By the end of the course, you will have acquired a set of practical skills and techniques that you can use to enhance your productivity and achieve your goals in a more focused and efficient way.

Streamline Your Process

Streamline your process by instituting prevention. So much time, energy, effort, and revenue is spent on constantly correcting problems and challenges, a one-time event. Prevention is a one-time solution, but must remain fluid in relation to changes that may occur.


Holism

Organizational silos are good and bad but must be rebuilt with a holistic integrator for knowledge sharing, cross-functionality, interoperability, and more. The human body knew how to do it, you can learn to also.

Case Study

Title: Optimizing Utilization Review Process at Adams Memorial Healthcare: A Holistic Approach
Introduction: Adams Memorial Healthcare (AMH) is a critical access hospital that is committed to delivering high-quality care to its community. However, challenges in the utilization review process were hindering efficiency and the appropriate level of care affecting length of stay and financial stability. This case study delves into how AMH employed a holistic approach, integrating goal setting, data analysis, and process optimization to enhance the utilization review process and improve financial outcomes.
Background: AMH, as a healthcare provider, faces the critical task of ensuring that resources are utilized efficiently while maintaining appropriate length of stay, the quality of care, reducing denials, and appropriate utilization of resources. The utilization review process plays a pivotal role in this endeavor, but inefficiencies were impeding its effectiveness.
Problem Statement: AMH identified inefficiencies in the utilization review process, sometimes non-compliant processes, including delays in authorization approvals, improper documentation, and inconsistencies in decision-making for level of care. These issues led to prolonged patient stays, increased administrative burden, and potential lapses in appropriate reimbursements for services provided.
Methodology: AMH adopted a comprehensive strategy to address the utilization review process challenges which included the use of a physician advisor which had been previously lacking:
Goal Setting: The hospital leadership set clear objectives, such as reducing the average review time by 30%, accurate level of care determinations as quickly as possible, and increasing authorization accuracy by 20% within six months.
Data Collection: Utilizing electronic health records (EHR) and utilization management software, AMH collected data on review turnaround times, approval rates, and reasons for denials.
Root Cause Analysis: Employing tools like the fishbone diagram, AMH identified factors contributing to delays and inaccuracies in the utilization review process, including inadequate staff training, communication breakdowns, and complex workflows.
Key Performance Indicators (KPIs): Relevant KPIs, such as review completion rates, denial rates, and resource utilization metrics, were established to track progress and measure the impact of process improvements.
Trend Analysis: Historical data was analyzed to identify trends and patterns in review outcomes, and throughput, enabling AMH to identify areas for improvement and anticipate future challenges.
Flowcharting: Process mapping and flowcharting techniques were used to visualize the utilization review workflow, identify bottlenecks, and streamline decision-making processes.
Time Management: Time-saving strategies, such as standardizing review protocols, implementing automated reminders, and optimizing staff schedules, were implemented to expedite the review process.
Solution Implementation: Based on the analysis, AMH implemented the following solutions to improve the utilization review process:
Staff Training: Provided comprehensive training to utilization review staff to enhance their skills in documentation, communication, and decision-making.
Standardized Protocols: Established clear and standardized review protocols to ensure consistency and efficiency in the decision-making process.
Workflow Optimization: Streamlined review workflows, eliminating redundant steps and automating routine tasks to expedite the review process.
Communication Enhancement: Implemented regular communication channels between review teams, physicians, and case managers to facilitate information exchange and resolve issues promptly.
Results: After six months of implementing the process improvements, AMH observed significant enhancements in the utilization review process:
Average review time decreased by 35%, surpassing the target set by hospital leadership.
Authorization accuracy improved by 25%, reducing the likelihood of denials and delays in patient care.
Staff satisfaction scores increased by 15%, reflecting improved workflow efficiency and reduced administrative burden.
Discussion: The success of AMH's utilization review process improvement initiative underscores the value of a holistic approach in addressing complex challenges in healthcare operations. By integrating goal setting, data analysis, and process optimization strategies, AMH was able to enhance efficiency, accuracy, and staff satisfaction in the utilization review process.
Conclusion: Adams Memorial Healthcare's experience highlights the importance of continuously striving for operational excellence through systematic process improvement efforts. By leveraging data-driven insights and fostering a culture of collaboration and innovation, healthcare organizations can optimize processes, improve patient care, and achieve better outcomes.






Meet the Creators


This course offers an exceptional mix of expertise from two different industries - healthcare and manufacturing. The course presenters, John Zelem, MD, and Jim Zelem provide unique insights into the business operations of these industries, based on their wealth of knowledge and experience in their respective fields. Although these industries may seem different, they share many similarities from a business standpoint. John Zelem, MD, is a seasoned healthcare professional with extensive experience in the field, including healthcare administration and management. Jim Zelem is an experienced manufacturing professional who has held various positions in the industry, from operations management, and process improvement, to supply chain management. John and Jim bring a practical, hands-on approach to their teaching, drawing on their years of experience to offer students invaluable insights into the business operations of healthcare and manufacturing.




Choose a Pricing Option