Prior authorization, as it stands, is one of the more antiquated components of the healthcare system. Its impact causes frustration throughout the care continuum, primarily for health plans.
From part one of our prior authorization series, 3 Major Challenges for Prior Authorization & How They Impact Your UM Goals, the current prior authorization process poses significant challenges for a health plan’s ability to effectively manage administrative efficiencies, costs, and the provider and member experience.
However, with Apixio’s AI-powered prior authorization solution, Apicare AuthAdvisor™, these pain points can be eliminated while also providing additional benefits not currently available in the market.
1. Improve Efficiency & Reduce Costs
The current prior authorization process is manually intensive, costing health plans an abundant amount of time and resources to review and respond to requests. However, a McKinsey analysis found1 that “AI-enabled prior authorization can automate 50 to 75 percent of manual tasks, boosting efficiency, reducing costs, and freeing clinicians at both payers and providers to focus on complex cases and actual care delivery and coordination.”
With Apicare AuthAdvisor, health plans are provided with AI-powered digital assistance that delivers predictive prior authorization decisions within the prior authorization workflow – allowing decisions to be made within seconds rather than days. As a result, health plans are able to reduce manual labor needs and cut unnecessary costs. Clients have seen over 50% volume reduction in manual prior authorization reviews.
Based on initial results from our clients, one of our customers saw 64,401 auto-approved prior authorization requests in production in 2022 Q1. They projected their annual savings of $6.4M directly due to avoidance of unnecessary reviews. As they continue to scale, we expect to see even more savings.
2. Drive Provider & Member Satisfaction
The time-consuming prior authorization process can make it more difficult for providers to deliver much-needed care, compromising the patient experience. In addition, because of the care delays, or sometimes no care at all, due to the current process, health plans may see member (Star Ratings) and provider satisfaction negatively impacted.
Apixio’s Apicare AuthAdvisor enables health plans to train their prior authorization response model to review historical provider performance and automate a response based on the provider’s performance. Providers will then receive timely responses, allowing members to receive timely care – driving improvements in the provider and member experience.
3. Application that Scales to your Needs
Some organizations expect health plans to apply their solutions within their workflows instantly. However, once enacted, implementing new workflows would likely take months to more than a year to build 1:1 connections between a provider and payer. That could mean years before these measures would make a difference across your provider networks and require months and months to build each procedure rule out by payer.
Our solution is able to be applied across your provider network at scale. Our approach is to support health plans to have an implementation within months. Our approach is consultative by analyzing and auditing your current prior authorization process. We then optimize and fine-tune requirements to build a custom data science model to be directly implemented into your health plan’s existing workflow. Health plans can achieve digital transformation today by leveraging the speed and scalability with the power of AI without a complete replacement of their current system – unlike any solution in the market.
Accelerate your Authorization Decisions with AI
Maintaining your existing prior authorization process will only exacerbate the situation with high costs, inefficiency, and poor member and provider experience. Apixio’s AI-powered prior authorization solution presents an immediate opportunity that addresses these pain points for health plans and allows for a scalable solution to be applied across their entire network.
Make the step to improve your organization’s prior authorization approach and see the results downstream with Apixio’s Apicare AuthAdvisor. Contact us to get started!
Source
1. AI ushers in next-gen prior authorization in healthcare | McKinsey. www.mckinsey.com/industries/healthcare-systems-and-services/our-insights/ai-ushers-in-next-gen-prior-authorization-in-healthcare. Accessed July 7, 2022.