Where technology can help with prior authorization burnout

Where technology can help with prior authorization burnout

It's no secret that burnout is a struggle across the healthcare industry, and the complex, time-consuming prior authorization process is one contributor. Technology can enable electronic prior authorization, a tool in utilization management designed to automate processes and provide faster responses and approvals. The efficiencies provided by technological tools should and do improve aspects of the prior authorization process, such as the time it takes from the submission of the request to the decision and communication of that determination to the physician and patient, as well as the level of effort required to support that turnaround time. The hierarchy of review and the rules and guidelines included the submission and communication channels such as portals, the abstraction of medical records from EHRs, which contain the documentation that substantiates medical necessity, all require human interaction in the current state, and most if not all of this intervention can be automated through the electronic prior authorization technology. A. The many time-consuming and financially burdensome processes involved in the submission of a prior authorization request, intake of that request, back-and-forth process of gathering of supporting documentation, manual review of the regulations and guidelines, issuance and communication of the determination, peer-to-peer consultation, appeal and submission of additional information, all contribute to burnout. Electronic prior authorization automates virtually every single step in the process and creates efficiencies that eliminate the financial burden – and much of the physical workload. The resultant improvements in provider, patient and even payer satisfaction obtained by eliminating the pain points of traditional prior authorization begin to rebalance the forces described above and restore the joy and reward for which most healthcare providers were looking when they initially pursued a career in medicine.




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