Prior authorization workflows remain highly manual in today's healthcare environment, even with advancements in machine learning and robotics process automation.
But technology-enabled services may provide opportunities to enhance efficiencies and consistency around the human components of these workflows, presenters explained during an Oct. 9 session sponsored by Access Healthcare at the Becker's Healthcare HIT + RCM Virtual Event.
Presenters were:
- Steve Kim, MD, co-founder, president and chief marketing and & strategy officer of Voluware
- David Tassoni, president, U.S. operations, Access Healthcare
Five key takeaways from the session:
1. Many of today's prior authorization workflows require human intervention. To illustrate this point, Dr. Kim, a pediatric urologic surgeon, recalled his office manager at his practice pulling out a three-ring binder full of more than 250 different prior authorization fax forms that his team had to fill out manually. He also recalled a dozen websites that his practice had to submit into. "I think the three-ring binder is really emblematic of what I see as one of the real core challenges around managing prior authorizations, and that's the highly manual nature of prior authorization submission workflows," said Dr. Kim.
2. Prior authorization workflows remain variable. Presenters largely attributed this to payers having different processes. They also noted a lack of a standard format. "Every payer has a different process. That localized knowledge is necessary, but when you have that much variability, that's where you get errors. That's where you get process adherence problems. That's where the quality doesn't happen," Mr. Tassoni said. "And when you don't have a whole lot of visibility, human error can really take on a huge impact. That's why cancellations [of services and procedures] occur because you had that human error in the first place."
3. Other challenges in the prior authorization process include predictability and availability, according to Mr. Tassoni. He said providers don't always know how long it's going to take to complete payer pre-certification requirements for coverage. He also said having the staff available at the right time to complete needed work is another challenge health systems face.
4. Tech-enabled services offer a solution to manual prior authorization workflow challenges. Using a tech-enabled service or solution helps optimize the prior authorization workflow by standardizing work, so that workflows are minimizing that handoff from team to team, said Mr. Tassoni. He also cited automation of non-value work, such as logging into websites, as a benefit.
5. Access Healthcare and Voluware's partnership on tech-enabled service yielded positive results. Revenue cycle company Access Healthcare partnered with Voluware, a provider of cloud-based, automated solutions for healthcare, on a tech-enabled service called Valer, which manages prior authorizations across payers. Dr. Kim said the Valer platform has the ability to reach upwards of 80 percent reduction in the manual processing times associated with prior authorizations during time motion studies (going from 16 minutes to two minutes). He said he has also seen health system clients reduce their staffing requirements by 20 percent, especially during the COVID-19 pandemic.
To view the session on-demand, click here. To learn more about Access Healthcare, click here. To learn more about Voluware, click here.