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Myndshft Blog

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November 16, 2022

3 Compelling Reasons that Buying Prior Authorization Software Blows Away Building It from the Ground Up

by Susan Lawson-Dawson | Prior Authorization, Revenue Cycle Management

“Rising demand for centralization and streamlining of healthcare administration is also anticipated to drive the market for electronic health records,” writes Grand View Research in its market analysis on EHR solutions.  Healthcare revenue cycle providers face a similarly rosy picture for market growth. But the potential for growth also means increased competition. 

Integrating prior authorization software in your platform could be a force multiplier for your business. Why? Take a look in our eBook: The Build vs. Buy Decision or read on for a sneak peak at some of the topics covered. . 

Your Customers Want & Need It

Prior authorization represents a top pain point among healthcare providers in both acute and post-acute care settings. The recently released MGMA Regulatory Burden Report notes that
82% of providers find prior authorization requirements “very” or “extremely” burdensome. 

The burden is growing too, with 89% of providers hiring additional staff or reallocating existing staff to complete the prior authorization workload. Helping your customers overcome this burden could go a long way to improving retention and creating brand champions. 

To build or to buy: that’s the big question. Here are three reasons partnering with a solution provider makes sense. 

1. Automating Prior Authorizations is Complicated

You need to  build to the latest standards for interoperability and data security. While it may be familiar territory for healthcare software-as-a-service providers, the next piece of the prior authorization puzzle may not be. 

With more than 1,000 payers, each with numerous plans and prior authorization guidelines, you’re looking at building an enormous payer policy library and rules engine to manage millions of unique combinations. It’s a complex undertaking and if it isn’t your particular area of expertise, building it with internal development resources may be more difficult than you bargained for. 

Which leads to the next reason. 

2. Cost Overruns are Commonplace

Scope creep leads to project delays. But putting the brakes on momentum isn’t the only problem with internal development projects. That’s because as the timeline extends, costs go up. Your plans to deliver AND your budget blow up. Not to mention that your IT team gets stretched thin, making it more challenging to handle routine maintenance and other core development activities. With IT talent in high demand, you need to strike a balance because adding staff is already problematic. (Plus, new people take time to get up to speed, which slows progress.) 

Which is why this next reason makes the list. 

3. Buying Speeds Your Time to Market

As noted earlier, your customers really want and need a better solution than time-consuming, error-prone, manual prior authorization. Integrating white-labeled prior authorization software into your existing platform allows you to go to market much faster than in-house development. 

Not only do you avoid the need to become prior authorization experts, but you reserve your in-house IT resources for other high-value projects. All while delivering an in-demand solution to your customers. 

There are plenty of considerations when determining whether you should build or buy. If prior authorization automation isn’t within your domain expertise, check out our eBook to take a deeper look at build versus buy considerations.