Superior HealthPlan's COVID-19 Surging Hospital and Facility Support
As the COVID-19 pandemic spreads across Texas, Superior HealthPlan's Utilization Management (UM) department has developed strategies to support hospital and facility partners in the event of a surge in cases. The UM department interacts with numerous health-care systems throughout the state with varying capacity to manage identified surges. The strategies developed support hospitals and facilities in increasing capacity for admission, by assisting with and expediting member discharge while decreasing barriers to transferring members to alternative facilities.
Surge support from Superior is activated when a hospital or facility has been identified as experiencing decreased capacity due to a COVID-19 surge. "Surging Hospitals" are identified as hospitals/facilities experiencing:
- Less than 10% Intensive Care Unit (ICU) available capacity or less than 15% overall available Inpatient (IP) capacity in high capacity/acuity facilities.
- Critical decreasing capacity of ICU or IP acute beds.
- Staffing shortage.
The priority is to unburden emergency departments of non-emergent members and increase IP capacity, by expediting emergency room transfers to other facilities and discharging or transferring members in IP settings. This is a collaborative effort between Superior’s UM department and the hospital’s/facility’s Case Management (CM) department. The strategies initiated will depend on the needs of the identified hospital or facility.
Identifying a Surge
Superior’s point of contact for the hospital’s/facility's CM department is the assigned Superior Concurrent Review Nurse (CCRN), or Superior Department Manager. The process for identifying a facility as a Surging Hospital is as follows:
- The CCRN will attempt to contact their respective facilities daily (or as able) to inquire about any needs or issues and updates on ICU capacity, in order to keep the hospital/facility on radar as a Surging Hospital.
- When a Superior Discharge Planner (DCP) is involved or made aware of a surge, they will obtain information from facilities as able and communicate to the CCRN/Manager.
- CCRN/DCP will encourage facilities to contact them directly for assistance with expedited needs, including any issues with discharge planning.
- For after hours, weekend and holiday support, Superior's UM/Prior Authorization (PA) departments will continue to maintain COVID-19 surge support through the 24-Hour Nurse Advice Line. The Nurse Advice Line will then contact the appropriate team.
- To reach the appropriate Nurse Advice Line, please reference the Nurse Advice Line section on Superior’s Provider Directory webpage.
- Once a hospital/facility is identified as a Surging Hospital, Superior will assist with facilitating timely transfer of members to an alternative level of care, or discharge to the member’s home.
- Examples include:
- Expediting PA of Durable Medical Equipment (DME) or supplies to ensure the member can safely be discharged to their home.
- Transferring a member to an alternative level of care, such as an approved rehabilitation facility.
- Examples include:
As a reminder, facility staff requiring after-hours support should call appropriate 24-Hour Nurse Advice Line. The Nurse Advice Line will ensure the appropriate team at Superior is contacted and made aware of the support needed. Contact information can be found in the Nurse Advice Line section on Superior’s Provider Directory webpage.
For additional information or questions about Superior’s COVID-19 surge hospital or facility support, please contact your local Account Manager.