Prior Authorizations are the bane of doctors existence and they affect the patient as well. Recently, I was able to sit down with Joe Anstine, CEO, and co-founder of PriorAuthNow , a company that is working to ease the tensions and difficulties of prior authorizations, to dive into this topic.
Many people may not know prior auths by their name, but much of care and treatment is controlled by them. So how are patients being impacted for good and bad by prior auths? The immediate impact is a delay in care. When seeking medical attention, doctors need to push back the visit in order to go through the prior auth process and determine if the visit will be paid for or not. This then leaves patients in need of medical help waiting until it has been cleared. PriorAuthNow is trying to step in to simplify this process for both side in order to speed this up.
Next we dove into the question: What’s the biggest thing blocking us from automating prior authorizations everywhere? There are a lot of nuances that don’t allow us to automate prior auths, but one is the customization of healthcare. Every patient has a different doctor, a different healthcare plan, and needs a different treatment. The customization of each patient then makes it extremely difficult to build out a standard that would allow automatization. Furthermore, prior authorizations are a weird intersection between clinical and financial data. Which then adds in a whole new mix of information to sort through and thus making a standard approach that much more difficult to create.
And on a cynic note, we have to consider the following: Are prior auths really just payors attempt to control doctors? Why would payors lean into fixing this problem? Anstine explains that there is an expensive fight happening between providers and payers that he calls “The Arms Race.” On one side there are doctors that want freedom to take care of their patients. On the other side are the health plans that need to make sure that these treatment plans are the appropriate ones and they’re not paying for care that isn’t needed. In many cases, PriorAuthNow has been able to step in and help both sides lower their arms and start to put the patient first.
With this ongoing friction, what would you tell a provider that is struggling with prior authorizations? How can you help them? PriorAuthNow has created a platform that is solely focused on the prior authorization use case. This allows them to fully model out the process, anticipating all of the exceptions that may appear. They work to connect the different departments and the patients in order to provide the best care and have it paid for. This essentially works to get rid of the administrative steps and brings the doctor and patient closer together.
Which then brings us to: what’s the future path for prior auths? The good news is, is that there is a lot of new technology that is in the market or being created that is working to make clinical automation better. The end goal being to bring the two ends of collecting data and getting the patient the care they need come together. Anstine says the best way to do this is through intelligent collaborations in a third party that can step in and take care of it for both sides.
To get more information on this topic and to hear the full interview, watch the video below!
Learn more about PriorAuthNow: https://www.priorauthnow.com/
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