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June 14, 2023

Improving Patient Outcomes: The Advantages of Prior Authorization Software in Value-Based Care

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

In the healthcare landscape, value-based care represents a paradigm shift, designed to improve outcomes and increase patient satisfaction while controlling costs. This model’s fundamental premise reimburses providers based on quality of care, rather than volume. The shift from ‘sick care’ to ‘health care’ offers a more proactive, holistic, and patient-centric approach. 

What will play a role in a successful transition from fee-for-service to value-based care? Everything from preventive screenings to adoption of robust health technologies like prior authorization software. Let’s dive deeper into the topic. 

5 key pieces of the value-based care puzzle

Moving away from traditional fee-for-service healthcare delivery poses numerous challenges. Providers (and payers, for that matter) need to reimagine long-held standards and processes. 

1. Emphasize preventive and wellness care

Preventive care plays a pivotal role. Preventive measures like routine health screenings, vaccinations, and annual check-ups can detect health issues in their early stages. Addressing such issues early takes a proactive approach, helping patients make informed decisions and mitigating more severe health concerns that might arise from an untreated condition. Not only does this improve health outcomes, but it also reduces overall healthcare costs over time. 

2. Engage and empower patients

Patient-centric models of care emphasize the importance of patients playing an active role in healthcare decisions. By leveraging health technologies, providers can enhance communication with their patients, making them more aware of their health status and treatment options. Technologies such as patient portals, telemedicine, and health apps enable patients to access their health information, communicate with healthcare professionals, and manage their care remotely, improving health outcomes.

3. Improve health literacy

Patient engagement and health literacy go hand-in-hand. Understanding health conditions and treatment options plays a crucial role in patients’ decision-making and adherence to treatment plans. According to The Center for Health Care Strategies, an estimated 90 million Americans have low health literacy. This contributes to 4X higher healthcare costs due to ineffective management of chronic conditions, reduced treatment compliance, and unnecessary ER visits, hospital stays, and readmissions. Providers can improve health literacy by using clear, non-medical language, visual aids, and providing educational resources. Ensuring patients understand their health can lead to better self-management, increased adherence to treatment, and ultimately, better health outcomes.

4. Enhanced care coordination

Value-based care also stresses the need for integrated, coordinated care. Integrated healthcare systems promote cooperation among different healthcare providers and specialists involved in a patient’s care. This eliminates the silos of care and ensures that all providers have access to a patient’s complete medical history, leading to more accurate diagnosis and personalized treatment plans. Furthermore, care coordination can significantly improve outcomes for patients with complex, chronic conditions, who often have to navigate numerous healthcare providers and treatment regimens.

5. Better use of data analytics

Both providers and payers can leverage data to identify trends, predict health risks, and evaluate treatment effectiveness. Predictive analytics can help identify high-risk patients for early intervention, thereby improving outcomes. Furthermore, providers can use data to measure and track performance. Such insights create a line-of-sight for continuous improvement and high-quality care.

How does prior authorization help move the value-based care needle forward? 

Prior authorization, the process used by payers to determine the medical necessity of prescribed procedure, service, or medication, aims to prevent unnecessary procedures, overutilization, and ultimately, control healthcare costs. Unfortunately, the traditional (manual) prior authorization process creates more problems than it solves. It is notoriously time-consuming and error prone, leading to treatment delays for patients and forcing clinicians and staff to focus on paperwork, rather than patients. This is where prior authorization software comes into play.

Automating the prior authorization process delivers measurable benefits and puts providers on a smoother path to value-based care. 

For example, treatment delays are often the by-product of a slow, manual prior authorization process. The prolonged wait times or treatment abandonment can lead to worsening of symptoms, disease progression, and increased patient anxiety. By automating the process with prior authorization software, providers and payers can turn around prior authorization approvals faster, leading to prompt initiation of care and improved patient outcomes.

A streamlined prior authorization process also improves care coordination. In value-based care models, coordinating care between different providers is critical for comprehensive and effective patient care. Prior authorization software allows for seamless sharing of authorization status and other relevant clinical data among providers. This integrated approach facilitates better decision-making, personalized treatment plans, and consequently, improved patient outcomes.

Prior authorization software can also indirectly enhance patient engagement. By reducing administrative tasks for healthcare providers, it allows them more time to engage with patients, understand their needs, and involve them in their healthcare decisions. Greater patient engagement is directly associated with better adherence to treatment plans and improved health outcomes.

Streamlined prior authorization benefits everyone

Improving patient outcomes in value-based care involves a multifaceted approach that includes preventive care, patient engagement, improving health literacy, integrated and coordinated care, and data analytics. The transition also necessitates embracing innovative technologies, including prior authorization software, an indispensable tool in the quest for improved patient outcomes. It allows providers to move away from a ‘sick care’ model to a proactive ‘health care’ system, ensuring high-quality, cost-effective care that truly focuses on the patient.

See what Myndshft prior authorization software can do! Connect with us today.