Electronic Health Reporter

By Christina Perkins, NaviNet vice president of product management and strategy, NantHealth.

Efficient and effective ways of exchanging information between patients, providers and payers have become even more important during times of crisis, like the COVID-19 pandemic, with a greater demand for urgent, high-quality care. Physicians need more time to devote to saving lives as the healthcare system is overwhelmed with patients and still bogged down by administrative tasks.

According to Sage Journals, the average doctor spends about 8.7 hours per week on administrative tasks, which amounts to nearly a full work day. With the current pace of the pandemic paired with the need for maintaining preventative healthcare through regular appointments, such as physicals or cancer screenings, physicians need as much time as possible to pay attention to the task at hand: patient care.

Technology is the powerful tool necessary to streamline physician workflows by increasing efficient, effective communication between payers and providers in order to determine the most appropriate treatment plan for an individual patient based on their condition and health plan. One such workflow that can oftentimes be quite time-consuming for payers, providers and patients due to disputes or other disagreements around a therapeutic path is prior authorizations.

Streamlining the prior authorization process can alleviate the burden for all stakeholders, reduce delays, and offer providers and their patients confidence they are getting the most appropriate care with the highest chance for success. With the right technology in place, prior authorizations can be streamlined greatly.

Leveraging electronic tools to enhance administrative workflows can make it clear to providers when and why a prior authorization is required, what information is needed for each kind of service, and which services are within the guidelines for treatment.

By implementing digital technologies to streamline processes like these, there is a greater reduction of time and money spent to arrive at the best possible treatment plan – bringing about a new era of value-based care. Giving doctors tools they need to efficiently get tedious administrative tasks done will greatly improve the treatment process for all stakeholders. This is the gateway into enabling true value-based care.

Interoperability also plays a critical role in uplifting value-based care by boiling down the superfluous tasks, reducing heavy administrative lifts for providers. Allowing a range of healthcare information technologies to exchange, interpret and use data cohesively consistently leads to higher quality care by relying on a value-based and evidence-based care system. There are three foundational ways in which efficient and effective exchange of information through the use of technology can be extremely valuable to the healthcare system, including:

• Creating Administrative Efficiency – focus electronic prior authorization technology on services that require medical necessity or policy reviews, such as high-cost care, through automated workflows. Once these processes are streamlined, there is a reduced risk of treatment abandonment, which improves the quality of care and timeline in which it is provided.
• Increasing Transparency – make complex payer rules for payment and prior authorization available to providers and patients for complete transparency via an online portal and use emerging interoperability standards and predictive analytics tools to identify required information from the start to reduce denials and speed up the prior authorization process, to ultimately begin treatment as quickly as possible.
• Enhancing Value-Based Care – use technology that references a comprehensive database of treatment plans to lead to more effective, evidence-based treatment decisions, which will ultimately reduce costs for all parties involved and result in higher quality care. Electronic tools are designed to simplify processes for payers and allow them to communicate effectively with providers and their staff with step-by-step guided information collection, which makes relevant medical policy information easy to find in the workflow.

Integrating digital tools into administrative workflows can save payers, providers and patients time, money and resources, which is especially crucial during a crisis, such as the COVID-19 pandemic, where high-quality care and streamlined reimbursement processes are ever-more essential. As one of the highest-cost business processes in healthcare, implementing digital solutions for prior authorizations can help alleviate many pain points for payers and providers. Advanced data-driven solutions ultimately give stakeholders the tools they need to treat and be treated in the most effective manner.