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August 21, 2023

The Impact of Delayed Healthcare on Marginalized Patients: How Prior Authorization Software Helps Remove Barriers

by Susan Lawson-Dawson | Healthcare Technology, Prior Authorization

Historically, marginalized communities have faced inequities in healthcare, but the COVID-19 pandemic shined a light on the disparities like never before. Age-adjusted data analysis by the Kaiser Family Foundation (KFF), for example, found that African Americans, Latinx, Native Americans and Native Alaskans all experienced higher rates of COVID-19 infection and death compared to Caucasians. No single solution can solve such a complex and entrenched problem, but technology like prior authorization software helps eliminate one well-recognized barrier to care. Let’s delve deeper into how these disparities manifest and how automated prior authorization can close the gap. 

Unraveling disparities in the wake of the pandemic

Before we dive in, let’s cover a few definitions. 

The Centers for Disease Control and Prevention (CDC) defines health disparities as: “preventable differences in the burden, disease, injury, violence, or in opportunities to achieve optimal health experienced by socially disadvantaged racial, ethnic, and other population groups and communities.”  

Defining factors for marginalized populations expand on the above to  include gender identity, sexual orientation, age, physical ability, cultural or language differences, socio-economic facts and geography, such as rural communities or urban population centers. 

During the pandemic, marginalized communities were especially vulnerable for several reasons. 

Lack of trust in the healthcare system

Particularly among African Americans, mistrust in the healthcare system remains high. Noting that the mistrust contributed to vaccine hesitancy among African Americans during the pandemic, an article published by EClinicalMedicine further notes, “Discrimination, experiences around racism, and fear of experimentation are but a few of the many elements that contribute to this mistrust, and ultimately negatively impacts the acceptance of and willingness to seek healthcare.” 

And it’s not just African Americans that approach healthcare with skepticism. Earlier this year, Fortune cited survey results indicating, “Women, ethnic minorities, people with disabilities, and individuals who identify as LGBTQ+ are far more likely to distrust their healthcare providers—and the healthcare system as a whole.” 

Socio-economic barriers 

The Kaiser Family Foundation analysis also pointed to increased health risk during the pandemic for people of color because they were “more likely to work in jobs that cannot be done remotely, to live in larger households, and to rely on public transportation.”  Those barriers have not disappeared in the post-pandemic world. In fact, they actually contribute to disparities in numerous ways—from difficulties getting time off from work for healthcare appointments to limiting minority participation in clinical trials. 

Treatment delays compound existing health disparities

Gaining access to healthcare remains a formidable task for many marginalized individuals, leading to poorer health outcomes. Waiting for treatments often turns manageable health concerns into severe conditions. 

For example, rural Americans often struggle with healthcare access. The Association of American Medical Colleges (AAMC) points out that “U.S. rural communities—from Appalachia and the Deep South to the Midwest and western states to Alaska and Hawaii—share common risks for poorer health.”  More than 60 million Americans live in rural and frontier communities with significant healthcare access problems. As. a result, efficient processes gain even more importance. 

Access to primary care and specialists can be challenging in rural areas. Patients that must travel hours from home, taking time off work, which contributes to treatment abandonment. The consequences are clear. According to the National Rural Health Association, rural residents have higher rates of age-adjusted mortality, disability, and chronic disease than their urban counterparts.

The uncertainty of waiting for essential healthcare can weigh heavily on mental health too. Several studies have found that limited healthcare access is associated with poorer mental health outcomes.

Prior authorization software breaks down barriers

Payers often require pre-approval before agreeing to cover the costs of specific medications, treatments, or procedures. While seemingly straightforward, manual prior authorizations are notoriously complicated and time-consuming. When dealing with marginalized populations, it becomes particularly cumbersome. 

As mentioned earlier, for example, rural healthcare providers often find themselves understaffed in terms of both clinical and non-clinical roles. As a result, they must balance patient care with an ever-growing pile of paperwork. This leads to greater treatment delays. Not only does it impact the number of patients that a provider can see a day.  Manual prior authorization also creates frustrating wait times for necessary care, which can lead to treatment abandonment. 

In addition, some prior authorization requirements may be implemented differently. A study published by the JAMA Network found that “Discriminatory benefit design (benefit design that prevents or delays people with complex or expensive conditions from obtaining appropriate treatment) through prior authorization requirements could be a systemic barrier that contributes to decreased PrEP uptake in the South.”  In fact, a required prior authorization for PReP to treat HIV was 37% in the South. On the other hand, the Midwest came in at 13%. The West and the Northeast were lowest at 6% and 2% respectively. Such disparities further marginalize patients, contributing to care delays and poorer outcomes. 

Bridging the gap with prior authorization software

As healthcare processes increasingly integrate technology, there’s a unique opportunity to reimagine the prior authorization landscape. 

  • Reducing administrative burdens: Prior authorization software reduces the strain on overworked staff, allowing them to focus more on patient care. This helps reduce provider burnout and improves job satisfaction. 
  • Faster processing: Because prior authorization automates data exchange, providers realize significant time savings and fewer preventable denials compared to a manual process.The dramatic reduction in time spent tracking down prior authorization requirements and duplicative data entry doesn’t just benefit providers. Patients connect to needed treatments quicker too. 
  • Restoring faith in healthcare: Particularly among marginalized patients, experiencing a more streamlined process—and improved care access—helps restore patients’ faith in healthcare systems, fostering trust and adherence to medical advice.

Looking forward to a more inclusive healthcare future

The challenges presented by healthcare disparities remain substantial. However, the integration of technology and a conscientious approach to patient needs can drive change. Prior authorization software is no silver bullet, but it does  present a tangible way forward. Leveraging technology can pave the way for a more inclusive healthcare system. It ensures that everyone, irrespective of background, enjoys timely and quality healthcare.

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