Is the entire Home Health utilization management department being cut out under Home & Community?
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When you say "it's history by the 2nd quarter" what are you referring to? What role/division etc?
The home health dept has made no money and has been ruined by the upper “leaders” who made horrible business decisions over the past year. I have no doubt the dept will be closed soon. It will just go back to the way it was before our dept launched in 2021- no prior auth needed for HH and just bill the health plan. Too many coordinators were hired, too many managers who do nothing, and way too many bad business decisions such as “approve all visits without reviews”, endless overtime for weeks, approve all visits on POC instead of just like half, and too many coordinators who refuse to actually send to MD for denial. No one is held accountable for actual UM. It is just pounded into us that we need to more hit “the magic number” of reviews per day. The program stopped being viable last spring. In my opinion.
Home healthcare is the future I don’t know why they would touch it.
Home health? Or another dept?
It appears that one entire department will be downsized and gone by end of 2nd quarter. Navihealth was a sh-t show since Optum acquired them. They never did get themselves together.
I hope nobody really believes prior auths are to make sure pt gets " the right care"
Because so many docs just really do not know what they are doing ...
Yes we were told to keep our options open unfortunately.
Home and Community is down BILLIONS-it’s discussed nonstop by leadership. They will be cutting programs and staff. There’s no doubt. Everywhere Shawna Gisch and Keith Anderson go results in major reductions. It’s why they are brought in to lead the org.
Come on, let’s get real here. Shutting down the entire authorization unit? That’s about as likely as the cafeteria suddenly serving five-star gourmet meals. Who’d handle all those thrilling insurance approvals, anyway? I’m sure patients and doctors are just dying to spend their free time navigating that maze themselves.
Look, before we start planning the “So Long, Authorizations!” bash, let’s use our noggins for a second. Authorizations aren’t just some pesky paperwork we can toss in the shredder. They’re kind of a big deal in making sure patients get the right care, doctors get paid, and insurance companies don’t have a meltdown every time someone sneezes near a stethoscope.
If there was even a tiny bit of truth to this wild idea, you can bet your last co-pay there’d be more info floating around. Medicare Advantage plans don’t just wake up one day and decide to axe entire departments for funsies. There’d be meetings, memos, and probably a whole lot of people running around like headless chickens.
So how about we cool our jets and wait for some actual facts before we start this rumor wildfire? Until then, let’s assume the authorization folks will keep on doing their thing, making sure the healthcare circus keeps on rolling. After all, without them, the whole system would go down the toilet faster than last night’s questionable burrito. Yay for paperwork, am I right?
They are being moved to a larger UM team Optum wide
Is this the division of HCC that was known as Navi Health?
They aren’t going to tell you they are getting rid of it. Just have to read between the lines sometimes.
Whoever posted this: Yes, it’s history by 2nd quarter. The order was put in to dismantle it.
Where did you get this information, without identifying yourself? I've gotten the impression that there will be layoffs, but didn't think they were getting rid of the whole program.
I hope not! But would like to know sooner rather than later.
Yes, it’s history by 2nd quarter. The order was put in to dismantle it.
I’m not a HHCC, but I heard they were warned of potential layoffs?! Basically told to keep their options open.
Yikes