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Myndshft Blog

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March 7, 2023

Preparing for the Gray Tsunami: Benefits of Prior Authorization Software for Long-Term Care and Home Health Care Organizations

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

According to the U.S. Census Bureau, by 2050 the number of Americans aged 65 and older will hit 83.7 million. That’s a huge leap since 2011, when the first Baby Boomers began turning 65. Is it any surprise that the retirement “coming of age” for Baby Boomers has been called a gray tsunami? Unlike a tsunami in nature which happens with little warning, however, we know that this wave is coming. How does prior authorization software help long-term care and home health care providers manage the rising tide of demand? 

Higher healthcare needs increase administrative burden

More patients over the age of 65 increases demand on healthcare providers beyond sheer numbers alone. The National Council on Aging notes that 80% of the over-65 population has a chronic condition, with 68% having two or more chronic conditions. These include: 

  • 58% – High Blood Pressure 
  • 43% – Coronary Heart Disease or Heart Failure
  • 31% – Arthritis
  • 27% – Diabetes 
  • 18% – Chronic Kidney Disease
  • 11% – Alzheimer’s Disease or Dementia
  • 11% – Chronic Obstructive Pulmonary Disease (COPD)

As demand increases and co-morbidities persist, providers will likely face another wave: prior authorizations. 

Currently, 48% of adults 65-years and older have Medicare Advantage (MA) plans. Based on 2021 data, MA plans logged 35 million prior authorization requests. Traditional Medicare also makes use of prior authorizations to manage utilization, so the total volume is considerably higher. 

Now, imagine the prior authorization volume when the 65 and older population peaks!

Prior authorization software can help

With staffing shortages still plaguing the healthcare industry, providers need to adopt more efficient processes to bridge the staffing gap and keep pace with growing demand. Prior authorization software addresses the challenges you face, offering numerous benefits for providers serving older Americans, particularly long-term care and home health care organizations.

Streamlined Prior Authorization Process

Prior authorization software automates the prior authorization process, reducing the time and effort common to manual or partially electronic transactions. It removes reliance on tribal knowledge or time-consuming research by automatically gathering data related to patients’ health and benefits information, providers’ clinical documentation, and payers’ plans and policies.  

It also helps in ensuring that the required documentation is complete and accurate, minimizing preventable prior authorization denials and rework. 

Improved Patient Care

Prior authorization software expedites what is usually a frustrating process for patients too. Instead of waiting on approvals, patients receive timely and appropriate care. This can lead to better health outcomes and improved patient satisfaction.

Reduced Staffing Burden

Like other industries, healthcare has experienced an exodus of workers. Between the Great Resignation, post-pandemic burnout and normal attrition, the Bureau of Labor Statistics projects that healthcare will see an average of 1.9 million job openings a year through 2031 due to the aging patient population and continued contraction of the workforce. 

A more efficient process means your staff can focus on higher value or more rewarding tasks. Not only does this help with the ongoing  staffing shortages by reducing manual work. It also improves staff experiences. In turn, better experiences can improve retention, so you can escape the cycle of constant training due to high turnover rates. 

Prepare now for future demand

Long-term care and home health care, in particular, face an uphill battle for adequate staffing. Since February 2020, the sector has lost nearly 229,000 workers—more than 14% of the workforce. This represents the worst job loss among all healthcare sectors. In fact, 60% of nursing homes in the U.S. have reported needing to limit new patient admissions due to staffing shortfalls. 

What’s more, understaffed long-term care has a knock-on effect for hospitals; if they can’t free up beds by moving patients into transitional care, it delays care for other patients or results in costly readmissions. 

Fortunately, fully-automated, end-to-end prior authorization is already available. Get in touch if you’d like to know more about Myndshft prior authorization software.