Prior authorizations are a burden for providers and patients alike. Many are hopeful, however, that automation could be transformational, putting patients at the center of their financial care journey and letting them access the healthcare they need.
During a session as part of Becker's Health IT + RCM Virtual Event, sponsored by Change Healthcare, Andrew Johnson, vice president for electronic prior authorization solutions at Change Healthcare, discussed the current and future authorization landscape, including opportunities for intelligent automation.
Five takeaways were:
- Authorizations consume provider time and delay patient care. Authorizations are largely a burdensome manual process, and denials are steadily increasing. For providers, prior authorizations increase administrative friction and contribute to provider burnout. They are also problematic for patients. According to the American Hospital Association, 30 percent of physicians have reported that prior authorizations have led to serious adverse events or patient harm.
- Adoption of electronic authorizations is accelerating, but slowly. Fully electronic prior authorization is growing for the submission portion of the process. However, that's only the tip of the iceberg when it comes to a fully touchless authorization process. "We still have a long way to go. At least one-third of all authorization transactions are done in a completely manual way," Mr. Johnson said.
- Intelligent automation is the first step in automating authorizations. Intelligent automation uses tools and technologies to improve the connectivity between provider organizations and payers. It also enhances the patient experience. Low value work like data entry, retrieval and submission is automated, which maximizes user efficiency. "Given the talent issues facing healthcare, the need for automation is significant. There’s a huge opportunity to change the game with automation," Mr. Johnson said.
- Providers and payers are exploring automation for various aspects of the prior authorization lifecycle. Examples include automating eligibility and benefits workflows, managing payer rules to ensure that providers don't request unnecessary authorizations and determining whether authorizations are already on file. According to Mr. Johnson, "Submitting an authorization is the next frontier of authorization automation. It starts with the low fidelity activity of integrating payer portals directly into provider workflows. Completion of questionnaires is also starting to be automated. This is a nascent part of the industry that many vendors are focused on, and it could significantly reduce overhead."
- The desire for strategic partnerships is growing. When automating authorizations, pure outsourcing relationships don't align incentives. The industry has a greater appetite for strategic partnerships. These may be relationships between payers and providers or collaborations between organizations and vendors. "As provider groups try to manage the transition from a largely manual authorization process to a largely interoperable one, many are turning to a blended model that leverages intelligent automation capabilities along with strategic partnerships for financial clearance expertise," Mr. Johnson said. "An outcomes-based strategic partnership focuses on the end goal of mutual benefit, which delivers as much automation as possible."
The authorization landscape is changing rapidly. Organizations need partners who can both address problems today and offer guidance during the ongoing journey of automation. The process will be evolutionary. "Intelligent automation is a great start and can reduce many of the high-volume, low-value tasks," Mr. Johnson said. "However, we also feel there is a transition period where authorization transactions will still require some manual intervention. Looking ahead, we’re optimistic that an exception-based authorization world is on the horizon."
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