Many organizations are turning towards a delegation model in which some of their providers’ more routine tasks are processed by a centralized team rather than in the clinic. Doing so offers the best opportunity for ensuring quality, efficiency, and improved revenues - not to mention a reduction in provider burnout caused by excess administrative work. One of the most common tasks that gets delegated to a centralized team is prescription renewal requests because they can be protocolized and, in many cases, can be handled by lower licensure levels.

If your organization is considering moving to a centralized model to process renewal requests, you may want to start by conducting a pilot with a subset of providers to prove its viability and determine the impact it can have on the organization. It also gives you time to make adjustments and gain provider trust and interest in the workflow before rolling it out to more providers.

Based on our experiences helping health systems move to a centralized workflow, here are some tips for setting up a pilot.

Develop detailed protocols

If you don’t already have protocols for prescription renewals, you’ll need to create them or work with a delegation support company like healthfinch, whose protocol library you can leverage. If starting from scratch, these may just be on paper to start and only include a small number of medication classes. A more advanced process will integrate these protocols directly into your EMR to save time and reduce the risk of human error or oversight. For your pilot, you’ll need to decide how detailed the protocols will be, how they will be applied to incoming requests, and any ancillary workflows that may result, such as patient follow up. 

Identify your provider population

Primary Care is a great place to find your pilot group members since they often have the highest renewal volume and the most variety in their requests. From this group, invite providers who are culturally aligned with the initiative and open to change. Depending on the size of your organization, the number of providers in this initial group could be 5-10. Be sure to also communicate expectations with your pilot providers. Let them know that feedback on protocols and processes is essential to ensuring success.

Assign centralized staff

If you already have a centralized team performing other clinical tasks, decide whether you will be adding renewals to their workload or identifying dedicated staff just for the pilot. Using current centralized staff will require additional training and monitoring to ensure appropriate staffing levels for the increase in work.

If renewal requests will be the first task to be centralized, it’s recommended that a couple of clinical staff are reassigned from clinics to work on the centralized team - at least for the pilot period. The number of staff needed will depend on how many providers are going to be supported, but an average ratio is 5-10 providers to one staff member.

Set parameters and goals

Determine how long the pilot will run for and how you will measure success. To give the pilot ample time to work out kinks and see an impact on efficiency, pilots are often run for 3-6 months.

Metrics should also be taken at the start of the pilot to develop a baseline. Be sure to track these same metrics throughout the pilot phase and again at the end. Some metrics you may wish to consider include:

  • Turnaround time - The average time to complete refill requests after being received by the team
  • Delegation rate - The number of refills that are being processed by the refill team vs the provider
  • Provider to staff ratio - The number of providers that can be supported by one refill FTE
  • Staff productivity - The number of refills one FTE can process per day or hour

It's also important to conduct random audits of requests to determine how well delegates are following the pre-determined workflows.


Once renewal requests are off providers’ plates, they usually appreciate the ability to shift their attention to other clinical tasks and, therefore, want to continue the centralized workflow. At the end of your pilot, you’ll need to determine if centralization services will expand to cover requests for more providers.

To get the full picture of the pilot’s success, don’t just look at the quantitative metrics. Talk with providers and staff to get their feedback, both during and after the pilot period. Make adjustments to optimize processes throughout the pilot and, if needed, don’t be afraid to extend it a bit longer to better understand the full potential.

Once centralized, you can begin rolling out to additional providers and working on optimization. It’s not uncommon for high performing centralized teams to reach a provider to staff ratio of 30:1 or more by leveraging a delegation support solution like Charlie.

Learn more about a centralized workflow and how standardized protocols enable successful renewal request delegation in our ebook, “Implementing Standardized Refill Protocols.”