Drowning in prior authorizations already? You're not the only one.
The Reauthorization Blizzard
As the days roll on, we all know it is that “blizzard” time of year - and I'm not talking about the flurries. This familiar chaos is the blizzard of activity required to reauthorize hundreds if not thousands of patients who hope to renew their medications annually.
Pharmacists, clinicians, and other healthcare leaders alike are stretched between fighting for prior authorizations and spending time on patient care, combatting the annual increase in:
- Insurance Policies and Formulary Changes
- Medication Expirations and Refill Limits
- Seasonal Illnesses
- Annual or New-Year Appointments
- Regulatory and Policy Changes
Diving Deeper: Regulatory and Policy Change Surges
The new year brings along a higher number of nuanced changes in prior authorization requirements and payer behaviors. For example, in a 2023 Report conducted by the Medical Group Management Association, 84% of surveyed organizations reported an increase in Medicare Advantage requirements over the previous year, an increase matched by the surge of Medicare Advantage enrollments and required re-authorizations for those existing Medicare beneficiaries who simply switched plans. MGMA also reported that nearly all medical groups surveyed (97%) said their patients experienced delays or denials for necessary care due to the administrative process and requirements varying widely across payers.
Trends such as this are seen across the industry and have likely already affected your organization these last few weeks.
The Impact of High-Volume Reauthorizations
When the blizzard hits hard, it's staff and patient care that suffer. Delays, denials, and tedious waiting periods can be both discouraging and dangerous; preventing patient's access to care and wearing down an already weary staff.
Diving Deeper: Staffing Challenges & Prior Authorizations
In a survey of physician practices in December 2021 the American Medical Association published that:
- Physicians and their staff spent a total of ~2 full days per week completing Prior Authorizations
- 40% of Physicians have staff who work exclusively on Prior Authorizations
- A whopping 88% of Physicians describe the burden associated with Prior Authorizations as high or extremely high
With the current state of staffing across the industry, more and more physicians and physician assistants are shouldering the burden of prior authorizations; a reportedly discouraging misallocation of resources.
Top 3 Features To Look For In A Prior Authorization Solution
With staffing as a continual challenge, we can’t afford to risk patient access while working through the blizzard. Plenty of technologies exist that alleviate different aspects of the prior authorization struggle. Some focus on speed, others workflow, and some (like D2's proprietary PA management platform) can do both.
After helping hundreds of healthcare leaders through this annual blizzard, here are a few high-ticket features we've seen in prior authorization platforms that truly simplify the reauthorization season:
1. Existing Workflow Integration
Nothing is worse than when technology takes more time to train your people on than it would to simply suffer through. Prior authorization platforms should be simple to implement and customizable to your organization's existing workflow.
2. Centralized Database with Detailed Patient Histories
Platforms without the ability to organize and record registered data or track internal collaboration become roadblocks during seasons of high-volume prior authorizations and reauthorizations. The best platforms actually facilitate these processes, eliminating the need to waste time researching payer behaviors, patient care history, or past actions.
This ensures both fast approvals and a less burdensome workflow.
3. Support From Real People
In a world in which adequate staffing is virtually impossible, the best technologies are supported by people who are willing to jump in and shovel the snow alongside you. Some technology partnerships will monitor PAs and call payers on your behalf - enabling your team to get more done with less labor.
UltraTouch Verify: A Complete Prior Authorization Solution
Designed, developed, and supported by D2's team of healthcare leaders, UltraTouch® Verify is a workflow-focused platform and complete prior authorization solution. From built-in smart protocols, to monitoring your team's efficiency, to analyzing payer behavior, UltraTouch Verify offers unmatched insight and control over your organization's prior authorization processes while keeping approval times to only hours.
Diving Deeper: How could patient engagement impact my prior authorization processes?
Pharmacies, hospitals, and physician offices should look to automate their patient outreach, as it has the power to simplify, streamline, and accelerate the prior authorization process by gathering crucial information before the blizzard even hits (ex: updated insurance information). D2's patient engagement technology, UltraTouch Engage, can accomplish this while requiring virtually no outbound phone calls, creating significant efficiency for staff and creating a significantly more positive patient experience. Seamlessly leverages alongside Verify, prior authorization submissions take in hours vs. days - spending more time helping than on hold.
Don't face the re-authorization blizzard alone.
Explore how D2 Solutions partners with healthcare organizations like yours to increase efficiency, minimize risk, and drive access.
