For almost a decade, healthcare stakeholders have sought to achieve the Quadruple Aim of healthcare: improved patient experiences, better outcomes, lower costs and improved clinical experiences.  The pandemic put the brakes on efforts out of necessity, but it also worsened clinician burnout.  Efforts to achieve those goals need a reboot, and prior authorization software could be part of the solution. But first let’s take a closer look at the problem. 

Rising burnout has consequences 

Approximately 63% of physicians reported feeling burned out in 2021, up 25% from the previous year and the highest number in a decade. Between 2020 and 2021, reports Healthcare Dive, more than 230,000 physicians, nurse practitioners, physician assistants and other clinicians left their jobs.  And it’s not just impacting clinicians. 

Non-clinical staff feel the pressure too, especially because many healthcare providers are short-staffed in administrative areas as well. Acknowledging that non-clinical staff play a critical role, one healthcare staffing firm notes, “Along with providing a powerful influence on how patients perceive their entire care experience, they are an important part of increasing patient engagement, improving care coordination, and helping patients connect with the resources outside of diagnostic care.” 

That’s right, they enable the Quadruple Aim too. It’s a team effort. So, why not give your team the tools that can help them succeed. 

Prior authorization software eases everyone’s (administrative) burdens

So much to do, so little time. It’s a common refrain across healthcare, but particularly so when you still rely on a clunky manual process for prior authorization. How does prior authorization software like Myndshft address productivity barriers and move the needle on the Quadruple Aim? 

Improved patient experiences

The patient experience doesn’t start in the exam room; it starts at the front desk or even online before patients visit. Having a fully automated, end-to-end prior authorization solution creates a fluid experience from benefits verification and eligibility to prior authorization requirements determination and submission. A more streamlined experience is just the start. 

A 2022 survey found that 83% of healthcare consumers want an accurate estimate of out-of-pocket costs in advance. Automatic patient financial responsibility calculations through prior authorization software deliver the information patients need to make informed healthcare decisions. This can go a long way toward creating positive patient experiences and help you comply with the No Surprises Act and other cost transparency measures. 

The best part? The software automates the entire process so instead of taking a half hour or more, the entire process from end to end only takes minutes. 

Better outcomes

When a treatment, procedure or medication requires prior authorization, the delays while waiting on approvals and reworking denials can lead to patient frustration, treatment delays or even abandonment. In fact, the MGMA’s Annual Regulatory Burden Report released in October 2022 revealed that 95% of providers report delays or denials for medically necessary care due to prior authorization requirements. 

More concerning is the fact that these roadblocks in patients’ care continuum lead to poorer outcomes. The AMA’s 2021 Prior Authorization Survey, for example, found that 91% of providers said that prior authorization has a “somewhat or significant negative impact” on patient clinical outcomes and 34% said delays led to a serious adverse event for a patient in their care.

Prior authorization software removes barriers to submitting clean requests. It uses a payer policy library and rules engine, along with intelligent automation, to identify if prior authorization is required, gather the submission documentation needed (no more, no less), and submits the request on the correct form using each payer’s preferred submission method. Because it’s done automatically, it reduces opportunities for typos, information gaps, or other preventable causes of denial, helping to ensure patients receive medically necessary care that enables better outcomes. 

Lower costs

A big reason for the push for value based care centers on lowering costs. Tackling the administrative costs associated with healthcare delivery could help that happen.  The CAQH Index estimates that switching to automated transactions—from benefit verification and eligibility to prior authorization, claim submission and attachments—could potentially save $17.6B. 

Where do these cost reductions come from? Automating the process with prior authorization software removes dependence on institutional knowledge. Staff productivity goes up, so you really can do more, with less—a crucial benefit since the MGMA’s Regulatory Burden Report also found that 89% of practices have had to hire or redistribute staff to work on prior authorizations due to the volume increase. That’s not easy since in the midst of a staffing shortage AND the great resignation. 

Improved clinical (and non-clinical) experiences

The burnout we mentioned earlier has a lot to do with experiences. Certainly the pandemic in 2020 and slow recovery since dramatically increased the pressures on both clinical and non-clinical staff. But the embers of burnout were already there. Over the last decade, providers have adopted a slew of technology solutions to further the Quadruple Aim, with some unintended consequences. 

According to the AMA, physicians report that the EHR has morphed from “… a way to document medical information for physicians and nurses into a tool to justify billing to Medicare and other payers.” Prior authorizations are another headache. Not only is it a burden administratively, but it’s also frustrating because providers would prefer spending that time helping patients.  The rise of telehealth and e-messaging has pushed providers to the brink administratively. 

Non-clinical staff also feel the frustration. Because they’re in patient-facing roles at the point of intake, on follow-up phone calls, and during billing and collections, non-clinical staff often bear the brunt of patient dissatisfaction. 

Prior authorization software puts the focus where it belongs

Back in 1927, a study in the Journal of the American Medical Association found that “… Physicians are most satisfied when following Peabody’s guide, including both scientific means to treat disease and thoughtful caring relationships with patients. Conversely, physicians are dissatisfied when these core values, the soul of medicine, are compromised.” We’d argue that non-clinical staff also feel as if the “soul” of their work is overshadowed by complex, time-consuming administrative duties as well. 

By implementing prior authorization software, directly in your existing EHR or other system of record, you create a smooth, relatively hands-free process that lifts the biggest frustrations off the shoulders of clinicians and staff members, boosting productivity and enhancing their work experiences overall. 

Talk with Myndshft to see how prior authorization software lets you focus on patients, not paperwork.