Patient engagement is a fundamental pillar of value-based care organizations, playing a crucial role in achieving better healthcare outcomes and overall patient satisfaction. To optimize this engagement, healthcare providers are leveraging innovative solutions, including automated prior authorization and psychographic segmentation of healthcare consumers. A streamlined prior authorization process, combined with valuable insights into patient behaviors, can strengthen care plan compliance and patient involvement in the healthcare journey.

Prior authorization causes more than an administrative burden for providers

Providers point to administrative bottlenecks as one of the biggest hurdles caused by prior authorization. But the paperwork predicament leads to bigger problems for patients. For example, 94% of providers report treatment delays due to prior authorizations, reports Healthcare Finance News. 

What’s more, the article cites additional AMA findings, including: 

• 80% say that prior authorization can at least sometimes lead to treatment abandonment
• 33% report prior authorization leading to a serious adverse event for a patient 
• 9% say such delays led to permanent bodily damage, disability or death 

Clearly, those kinds of results don’t lead to engaged patients. Instead, they feel defeated and disengaged. And because of this, momentum toward a value-based care future stalls. 

Prior authorization software smooths the patient care journey

Fully-automated, end-to-end prior authorization software accelerates the process in a systematic way. 

• It verifies plan and group specific prior authorization requirements instantly by breaking down the silos between patients’ health and benefits information, providers’ clinical documentation, and payers’ plans and policies. At Myndshft, we call this Collective Healthcare Intelligence™.
• It pre-checks for errors, missing information, and medical necessity, eliminating preventable denials so common to manual, repetitive data entry. That eliminates one hurdle right off the bat. 
• It submits the prior authorization request on the appropriate form and via the payer’s preferred submission path. (And it’s already aligned with pending interoperability requirements coming from the Centers for Medicare and Medicaid, so you don’t have to worry about regulatory compliance on that front—now or in the future.) 
• It enables status monitoring for all prior authorization requests in one convenient location. No more visiting multiple payer portals or making numerous phone calls—and listening to bad hold music ad nauseum—to determine the status. In fact, when the status changes, you receive an email notification so even if you’re not logged into the status dashboard, you’ll know what’s happening. 

With more efficient and accurate handling of prior authorizations, you can eliminate unnecessary delays or denials, ensuring that patients get the timely care they need. 

Not only does prior authorization software  increase the speed of care delivery, but it also mitigates the risk of treatment abandonment due to frustration and confusion from denied services. This fosters trust between patients and healthcare providers by creating transparency in the approval process. 

In turn, this tool enhances patient compliance and satisfaction, promoting overall engagement in their healthcare journey. But it’s just one step in driving true patient engagement. 

Psychographic segmentation turns patient communications into action-drivers

While automated prior authorization  improves the operational aspect of healthcare delivery, understanding patient behavior remains a significant component in promoting engagement. This is where psychographic segmentation comes into play.

Psychographic segmentation is an approach that categorizes patients based on their lifestyle, values, attitudes, motivations, and preferences. Unlike demographic segmentation, which focuses on age, gender, or location, psychographics delve deeper into understanding what influences a patient’s health behaviors.

In a recent interview, Upfront Senior Vice President of Consumer Science and Psychographics Brent Walker shares how psychographic segmentation helps providers align their patient communications and care approach to resonate more soundly with individual patients.  “Psychographics pertain to patients’ attitudes, priorities and personalities, and are core to their motivations and communication preferences. You can remove the barriers, but if you’re not touching upon the right motivations for individual patients, some may still disengage. Unless you resonate with them and help them understand why a treatment, medication or lifestyle change is necessary, you won’t activate true engagement,” Brent explains.

Whether it’s using specific language, providing personalized health education, or crafting a unique care plan, psychographic segmentation  enables providers to speak each patient’s language, promoting better understanding and engagement.

In fact, understanding a patient’s psychographic segment allows providers to better predict health-related behaviors, such as how they may respond to a particular treatment plan or their likelihood of following through with medication adherence. This valuable insight empowers providers to implement effective strategies that will boost compliance and encourage active participation in their care.

Brent further notes, “As we move closer to value-based care, providers recognize that patient engagement represents a make-or-break moment. If the patient fails to follow the care plan, health outcomes aren’t going to hit and health systems will bear the risk and lose money.” 

Do you have the right tools to support the transition to value-based care? 

As the healthcare landscape continues to evolve towards value-based care, tools like automated prior authorization and psychographic segmentation built into your patient engagement efforts  have emerged as vital elements in reducing treatment abandonment and maximizing patient engagement. 

By reducing preventable delays and denials and gaining a deeper understanding of what motivates patient behaviors, healthcare providers can deliver more personalized, timely, and effective care—the very essence of value-based care organizations. As we look towards the future of healthcare, the integration of these tools into everyday practice will be instrumental in advancing patient engagement and overall healthcare outcomes.

Interested in seeing automated prior authorization in action?  Connect with Myndshft to arrange a demo.