Improving Care, Reducing Waste: CenCal Health’s Approach to Efficient Prior Authorization

Key takeaways:

• CenCal Health faced challenges with its prior authorization (PA) process for advanced imaging which hindered access to appropriate diagnostic tests.
• Premier’s Stanson Health’s Radiology Benefits Management (RBM) solution streamlined CenCal Health’s workflows with a user-friendly portal and introduced a collaborative peer-to-peer outreach model, enabling radiologists to consult directly with providers for more clinically appropriate decisions.
• CenCal Health achieved nearly 60 percent imaging request reductions through voluntary adjustments, reduced unnecessary procedures, improved provider satisfaction and maintained 100 percent compliance with relevant state and federal regulations, all while enhancing care quality for its health plan members.

CenCal Health, a Medi-Cal Managed Care health plan serving over 242,000 members in Santa Barbara and San Luis Obispo counties, is committed to improving the health and well-being of its communities. The organization focuses on delivering access to high-quality health services tailored to the needs of its diverse population, ensuring patients receive the care they need while fostering strong relationships with providers.

Managing advanced imaging services, such as CT and MRI scans, plays a vital role in this mission. However, challenges with prior authorization (PA) processes—including inefficiencies, provider dissatisfaction and unnecessary delays—posed significant hurdles. Recognizing the need for a more effective solution, CenCal Health implemented Premier’s Stanson Health’s Radiology Benefits Management (RBM) solution in 2015. This partnership has since supported efforts to improve how the health plan manages imaging requests, helping to create better experiences for providers, patients and internal operations.

Streamlining Prior Authorization

Before adopting the RBM solution, CenCal Health’s PA process struggled to balance operational demands with clinical priorities. Providers voiced concerns over time-consuming workflows that often-delayed patient care. These inefficiencies created barriers to appropriate imaging.

Premier’s RBM solution brought a new philosophy: prioritize collaboration over denial. At the heart of this model is its peer-to-peer outreach, where radiologists consult directly with ordering providers to ensure imaging requests align with clinical guidelines. This consultative approach replaces automatic denials with meaningful dialogue, leading to better outcomes for patients and providers alike.

“The technology’s radiologist outreach ensures we’re making clinically appropriate decisions,” said Marina Owen, the CEO of CenCal Health. “Providers feel supported, which strengthens trust across our network.”

Efficiency Gains Through Smart Tools

Premier’s advanced tools have been instrumental in streamlining CenCal Health’s workflows. The user-friendly physician portal allows providers to quickly submit and track authorization requests while accessing clear clinical criteria. This transparency reduces administrative burdens, freeing up valuable time for providers to focus on patient care.

“Providers often tell us how they appreciate the simplicity and clarity of the portal,” said Owen. “They can submit requests seamlessly and get immediate feedback on criteria which has drastically reduced delays.”

For CenCal Health’s internal teams, the technology provides real-time visibility into authorization statuses, improving communication and decision-making. This capability has been especially valuable for case managers and auditors, who rely on it to monitor compliance and operational efficiency.

The integration of these tools has resulted in a more seamless PA process, with fewer delays and clearer communication across all stakeholders.

Results That Matter: Reducing Waste and Improving Care

Premier’s RBM solution has played a key role in optimizing imaging approvals. Notably, nearly 60 percent of imaging request reductions have come from voluntary provider withdrawals or redirections to more appropriate studies, significantly reducing unnecessary procedures and patient radiation exposure. This approach ensures that patients receive the right test at the right time, enhancing care quality while avoiding wasteful spending.

In addition, the solution has helped CenCal Health maintain compliance with relevant state and federal regulations, a critical achievement for a health plan serving Medi-Cal members.

Looking to the Future

By integrating Premier’s RBM solution, CenCal Health has redefined how it manages advanced imaging services. The partnership has helped to optimize workflows, improve provider relationships and deliver better outcomes for members—all while maintaining regulatory excellence.

“The RBM solution gives us the confidence that we are making the best possible decisions for our members and our providers,” said Owen. “This partnership has been instrumental in shaping how we approach imaging management.”

As CenCal Health continues to serve its communities, Premier remains a key ally in driving innovation and advancing patient-centered care. Together, they are setting a new standard for effective and efficient imaging management.

For more on this topic:

• Learn more about how Premier can help you streamline the PA process.