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Myndshft Blog

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May 8, 2023

How Prior Authorization Software Helps You Strike the Right Balance Between Automation and Personalized Care

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

In the last decade, the revenue healthcare providers collect directly from patients climbed from 10% to 30%. Now that patients have more skin in the game, so to speak, their expectations have changed. They want price transparency, convenience, and personalized experiences. To top it off, they’re willing to shop around for a different provider or insurance plan if you fall short on those expectations. Who do they blame when a cumbersome prior authorization process leads to care delays or preventable denials? You. How do you provide a more streamlined, less frustrating patient/member experience? With prior authorization software

Healthcare consumerism has evolved over time

Patients were first referred to as consumers back in the 1930’s, so healthcare consumerism isn’t exactly a new concept. It languished, however, until the rise of managed care organizations in the 1980’s spurred greater consumerism. Patients were increasingly being asked to share the cost of their care. As a result, they began to take a more active role in their healthcare decisions. After passage of the Affordable Care Act, consumerism shifted into overdrive. 

Technology, the internet, and social media had already made it easier for patients to access health information, compare prices, and share their experiences with others. Then in 2013, the Marketplace opened. Patients could shop around for health insurance plans, with many opting for low-premium, high-deductible health plans that expose them to greater financial responsibility. 

As a result, healthcare consumerism has emerged as a significant trend, with patients demanding an experience that matches those of other service sectors. Patients are now seeking healthcare experiences that are as seamless as those in the hospitality, airline, or ecommerce industries, given the higher out-of-pocket costs they are incurring.

How does prior authorization software address expectations

Sure, your patients or members do not interact directly with prior authorization technology. Maybe you’re wondering why it matters compared to patient-centric digital solutions like an engagement platform. But prior authorization has a direct impact on the patient experience. 

Faster access to care

For example, prior authorization software enables providers to move through eligibility and benefits verification to prior authorization in just minutes. Software requires limited manual data entry, afterwards pulling in relevant information as determined by payers guidelines. This reduces provider-payer friction and  the potential for preventable denials that delay patient treatments. Plus, both providers and payers benefit because fewer reworked claims frees both sides from extra administrative work. Removing barriers to care creates a more positive experience for your patients or members. 

Better health outcomes

In addition, faster access to necessary treatments and medications can have a significant impact on patient health.. This is especially true in care journeys that benefit from personalized medicine. In oncology, many new and innovative diagnosis and treatment options using biomarkers are subject to prior authorization. Genomic testing, for example, can reveal the most effective route when treating a patient for cancer. If you can quickly process prior authorization requests using automated prior authorization software, the benefits that your patients gain from personalized care can mean the difference between simply surviving to actually thriving. 

More time for patients (instead of paperwork) 

When staff and clinicians get bogged down in complex prior authorization requests, they have less time for patients. By freeing providers from one of the most time-intensive aspects of their daily work, prior authorization software helps them focus on higher-value, more rewarding tasks. After all, no one pursues a medical degree because of a love for paperwork. And when patients feel they have your attention, it makes for a better experience all around. 

Increased patient engagement and satisfaction

Frustrating delays and denials can lead to treatment abandonment. On the other hand, the streamlined process offered by prior authorization software reduces delays and denials. This encourages patients to stay focused on their own health and wellness.

In addition, a key piece of generating patient satisfaction comes from price transparency. Prior authorization software calculates patient financial responsibility up front, using a patient’s exact benefits details including deductibles and co-pays. Last year, we reported results from a healthcare consumer survey that nearly 90% of patients prefer knowing financial responsibility before accessing care. By providing a clear view of cost, providers (and payers) check the box on a major driver of patient/member satisfaction. 

Prior authorization automation improves efficiency, reduces administrative burdens, and supports better patient outcomes. By balancing automation with personalized care, you can ensure that patients have experiences that they want to share, for all the right reasons. 

Myndshft makes it easy. Connect with us to learn more about prior authorization software.