blue connect dots

Myndshft Blog

blue connect dots

April 11, 2023

Disrupting Healthcare Inequality: How Prior Authorization Software Levels the Playing Field for Patients

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

Recently, Jay Bhatt, the director of Deloitte’s Health Equity Institute, told Chief Healthcare Executive,“For the first time that I can remember in my lifetime, I can see greater alignment of stakeholders around health equity than I’ve ever seen before.”  While payers, providers and government agencies seem to be on the same page, the fact remains that achieving health equity demands significant change. Prior authorization, a process in which healthcare providers must obtain approval from payers  before delivering certain treatments or services, can sometimes act as a barrier to achieving health equity. So let’s take a closer look at why health equity has become a priority, the  role of prior authorization as a barrier to health equity and how prior authorization software can help remove these barriers.

The pandemic placed a spotlight on healthcare inequality 

The pandemic disproportionately affected marginalized populations, including racial and ethnic minorities, people in lower socioeconomic status, and those living in densely populated areas. They often faced higher infection rates, severe illness, and death due to pre-existing health conditions and limited access to healthcare. Lack of insurance, underinsurance, and limited availability of healthcare facilities—especially when infection rates peaked—made it more challenging for these individuals to receive timely care or testing during the pandemic. 

What’s more, many essential workers come from these marginalized populations. As a result, they faced a greater risk of contracting COVID-19 due to the nature of their jobs, which often involved close contact with the public or coworkers. Health Affairs notes that 34.5% of the workforce—50 million people—qualified as both frontline and essential workers, with no option to work from home. Because of this, the article points out, “Women, people of color, and those of lower socioeconomic status are the most likely among all workers to hold frontline positions that require in-person work and the least likely to have paid sick leave.” 

Prior authorization denials can result in delays so claims can be reworked, treatment abandonment which directly impacts patient outcomes or higher out-of-pocket costs that hit patients’ wallets. This can disproportionately affect low-income patients, who may be unable to afford necessary care without insurance coverage.

Data gaps became more apparent as the pandemic continued

COVID-19 also showed shortcomings on the data front. Data on race, ethnicity, and socioeconomic status were often incomplete or missing, making it difficult to accurately assess the impact of the pandemic on different communities. Today, healthcare stakeholders recognize the need for more comprehensive and disaggregated data to better understand and address health inequities. 

One reason for the lack of data boils down to the fact that many public health systems do not collect or report on this information consistently or comprehensively. A lack of trust between marginalized communities and public health institutions contributes to the problem as well.  

Having better data on race and ethnicity, social determinants of health and other factors can lead to better decisions that narrow the gaps. 

  • It helps public health officials and policymakers identify and address health disparities and discover answers as to why marginalized communities experience higher rates of chronic health issues, virus transmission and more. 
  • It improves the targeting of interventions and resources to those who need them most. For example, if data shows that low-income communities are disproportionately affected by a chronic condition, such as diabetes, policymakers can allocate funding to support those communities in accessing healthcare, personal protective equipment, and other resources. 
  • It builds trust between marginalized communities and public health institutions, by demonstrating a commitment to understanding and addressing health disparities.

Prior authorization creates another barrier to care

Prior authorization directly impacts access to care, which only exacerbates existing inequities in the healthcare system. 

Traditional prior authorization processes can be time-consuming and bureaucratic, potentially causing significant delays in receiving necessary treatments. These delays can lead to worsening health conditions and reduced quality of life. Among marginalized populations, prior authorization can be particularly challenging. Language barriers, for example, make it harder for some underserved populations to navigate the ins-and-outs of insurance coverage (if they have it) in order to make decisions. 

 Prior authorization places a heavy administrative burden on healthcare providers. It takes up valuable time and resources better spent on patient care. This can result in reduced access to care and increased health disparities. This is especially true for rural hospitals and ‘safety net’ healthcare providers. They must juggle limited resources with demand, and the administrative inefficiencies of manual prior authorization distracts them from their mission. In letter of support for the Rural Hospital Support Act introduced this month, the American Hospital Association (AHA) said, “Rural hospitals are essential access points for care, economic anchors for communities and the backbone of our nation’s rural public health infrastructure.” Faced with ongoing financial and staffing pressures, rural hospitals and other financially-strapped and understaffed healthcare providers need solutions that enable limited staff to do more, with less. 

Prior authorization software fits the bill. 

Prior authorization software enables health equity

Automated prior authorization may not solve all healthcare inequities, but it can certainly contribute to achieving more equitable care. By combining intelligent automation with real-time data exchange, prior authorization software significantly reduces the time it takes for providers to submit requests, as well as reducing preventable errors typically occurring in a manual process. 

Not only does this help get patients connected to needed care, but by automating the prior authorization process, healthcare providers lower administrative costs and increase capacity for care—a major advantage, particularly for resource-strapped ‘safety-net’ healthcare organizations. 

The administrative barriers posed by the traditional prior authorization process have been well documented. By relieving the strain on staff and clinicians, prior authorization software streamlines the process, lowers operational costs, and frees people to focus on patients, not paperwork. And that brings us closer to a future where every person receives equal access to the healthcare services and resources they need.

Interested in seeing how prior authorization software works?  Connect with us to arrange a demo.