The prior authorization process is still primarily manual in many healthcare organizations, which places significant financial and administrative burdens on providers, health plans and revenue cycle staff.
This burden is likely to continue unless the prior authorization process is intelligently redesigned and automated, explained two authorization experts from Aurora, Colo.-based UCHealth during a July 28 webinar.
During the webinar, hosted by Becker's Hospital Review and sponsored by Waystar, the experts described how UCHealth implemented intelligent automation into the authorization process, leading to financial improvements and full-time employee utilization efficiencies. They also shared what UCHealth's authorization process looked like before implementing Waystar's automation software, as well as best practices and lessons learned.
The panelists were:
- Kerre Valtierra, senior director of operations for patient line, ambulatory referral and authorization at UCHealth
- Brent Rikhoff, director of pre-access at UCHealth
Here are five key points discussed in the webinar:
1. A primarily manual prior authorization process drives inefficiencies.At UCHealth, prior to implementing an automated authorization solution, the process was very manual and time-intensive for staff, explained Ms. Valtierra. For example, employees were manually entering patient information into payer portals or conducting follow up calls with the insurers. In total, this meant staff was spending about 60 to 70 percent of their day solely following up on pending requests. "This reduced the time we had to submit any new accounts. They were just trying to close out the ones they started and we could not get that far ahead," Ms. Valtierra said.
2. When selecting and evaluating an automation software and vendor partner, identify the top priorities and must-haves for your organization. As a result of the inefficiencies, coupled with UCHealth's growth as an organization, the health system wanted to find a partner to help automate the authorization process to free up staff time and realize savings. "We sat down and figured out what we need this product to have. At the end of the day, what are our top priorities — what do we want to make sure is there from an operational standpoint, usability standpoint and maintenance standpoint?" Ms. Valtierra said. At UCHealth, the authorization leaders wrestled with those questions and decided their top priorities were to reduce the number of staff touches per account, decrease the manual work for staff and ensure the software works within their EHR. In addition, the automation solution needed to be low maintenance and the partner needed to be reliable, Ms. Valtierra said.
3. Understand the goals your organization wants to achieve with automation and track them. At UCHealth, the automation leaders set several goals, including increasing automation by 60 percent, decreasing denials related to prior authorizations by 30 percent, supporting growth at the organization without adding full-time staff and increasing service level by getting accounts out the door rather than just doing follow up work, Ms. Valtierra explained. Mr. Rikhoff added that it is important to regularly evaluate, engage and track these metrics to determine the reliability of the product. "This is not magic, it's not a super pill. There needs to be controls in place to monitor the effectiveness and reliability of the product," Mr. Rikhoff said.
4. Automating the authorization process helped UCHealth realize savings and FTE efficiencies. Since implementing Waystar's automation software in June 2019, UCHealth has seen gains in automation and efficiencies, Mr. Rikhoff said. For example, the number of authorizations that don't need a staff touch has increased to an average of 40 percent and peaked at 47 percent in January of this year, Mr. Rikhoff said. This has equated to a FTE savings of about nine employees per month, according to Mr. Rikhoff. Additionally, UCHealth is seeing a 46 percent average monthly decrease in the volume of denials related to authorization.
5. Involve key stakeholders, like front-end users and IT experts, in the process and rollout.One of the tips the panelists shared was to engage important stakeholders in the process, from selecting a vendor partner to rolling out the software and optimizing it. Mr. Rikhoff explained that he wishes UCHealth engaged its IT partners sooner because they had a lot of great questions that helped find the right product and optimize the product for the organization. In addition, it is important to engage the staff that will be using the new product, Mr. Rikhoff said. "We [as leaders] aren't in the weeds on all of the policies, procedures and you really need those superusers to help you call out where roadblocks may happen and help you solve problems before they exist," Mr. Rikhoff explained.
To listen to the hour-long webinar, click here. To learn more about Waystar, click here.