The recently concluded Fierce Health Payer Summit focused heavily on the many challenges surrounding prior authorization. Many presenters discussed the challenges from a patient perspective, while others tackled the clinical side by assessing the acute need to improve data exchange and interoperability between payers and providers.
Whether patient or caregiver, the goal is obvious: achieve more rapid, accurate, and economical data sharing. The good news is that viable technological solutions to make that happen exist today, among them digital, cloud, and fax.
This secure, reliable technology has long been the “connective tissue” between payers, providers, and other entities across the healthcare continuum. And now advances in cloud fax are allowing it to do more than drop off documents into an EHR or other system. AI-driven intelligent document processing can extract and organize unstructured information in seconds, making the payer-provider exchange ultra-efficient without removing the human component. For example, prior authorization approvals now can be expedited through the integration of AI, and denials can be routed to specialized staff for review.
AI, cloud fax come together for new solutions
These new productivity pathways can result in real savings in the prior authorization process, where costs are creeping ever higher. One attendee reported an average cost per prior authorization for providers is $20, a figure that soars to $120 for payers. Staffing is a significant piece of those costs, with another attendee saying they have three full-time employees doing nothing but processing prior authorizations. If they could transition those people to other work, the attendee added, there’d be room to bring on more clinical staff.
Other areas where the use of AI to streamline document delivery and enhance productivity includes more rapid patient and provider access to data. Benefits navigation, clinical guidance, and care delivery information are all areas providers at Fierce said they would like to see enhanced. They also highlighted point-of-care systems, where having more in-depth background information before the first encounter could speed diagnosis.
Creating momentum for new approaches
The goal now is to take interoperability concepts off the design table and get them into the real world. As noted above, that’s already happening in the cloud fax world. Adaptive technology such as Concord’s Practical AI suite of solutions is helping payers and providers with everything from prior authorization to intake processing, member enrollment, claims payment and much more. We stand ready to do more as payers work to strengthen their connections to providers and others in terms of data access.
There are challenges, to be sure: disparate systems, security protocols to be aligned, just to name two. But a future with easily shared information between payer and provider, speeding business operations while substantially improving patient care, will be worth all the time and effort.