Electronic prior authorization helps practice reduce 24 hours of manual work per week

Harmony Park Family Medicine in Arkansas is excited about streamlining its prior authorization process to improve patient access to quality care.

THE PROBLEM

Prior approval and management in the industry has traditionally been a cumbersome process that can cause unnecessary delays in patient care, largely due to the manual work involved.

It was no different at Harmony Park Family Medicine. Provider staff spent hours each day calling, emailing, and faxing relevant demographic and clinical information needed to begin the prior authorization process with payers, which is typically a multi-step, back-and-forth interaction rather than a simple question and answer.

“We needed a way to improve the speed and transparency of the prior authorization process to reduce administrative burden and improve patient access to care,” said Yvonne Dooley, COO of Harmony Park.

PROPOSAL

Before the organization implemented it automated electronic prior authorizationPatients often became frustrated with their healthcare providers because of the time it took to obtain prior authorization. This could sometimes lead to patients forgoing the care they needed.

“An automated electronic prior authorization workflow would alleviate the heavy administrative burden on our employees by creating an efficient and consistent process with all necessary information and requests directly in their workflow,” Dooley explains.

“In addition to making the entire process faster and more transparent, a streamlined process would expedite access to care in anticipation of better health outcomes,” she continued. “Furthermore, the manual nature of the prior authorization workflow inevitably leads to errors, which can compromise patient care, and that’s another bottleneck we wanted to solve.”

TOOK UP THE CHALLENGE

To automate pre-authorization, Harmony Park partnered with Humana, its payment partner; Availity, a real-time health information network; and athenahealth, her EHR vendor. The three worked together to develop an end-to-end electronic prior authorization process using the Da Vinci Burden Reduction Implementation Guides.

“These guides are a set of standards designed to make the prior authorization process more efficient and streamlined. By using them, we can accelerate the approval of these requests and provide an improved, seamless, end-to-end experience for patients, providers and payers,” Dooley said.

“By creating a seamless data exchange to connect the Humana and athenahealth platforms through Availity, data could be exchanged effortlessly,” she continued. “Once trained on the new workflows, this direct connection allowed our care staff to document and sign orders to initiate prior authorization with all necessary data and requests directly within their workflow.”

This, combined with the speed and transparency that Harmony Park now has throughout the process, has meant that staff no longer have to spend hours making phone calls or sending emails or faxes, which has significantly reduced the administrative burden on staff. It also means that patients can receive care in a more timely manner.

RESULTS

The results of this collaboration were so strong that Harmony Park earned a 2024 KLAS Points of Light Award for reducing inefficiencies and improving the patient experience. Specifically, Harmony Park saw improved caregiver efficiency, saving staff 24 hours of manual labor per week.

“Additionally, by eliminating manual prior authorization processes on our end and on the payer’s end, patients can receive care more quickly to achieve better health outcomes,” Dooley noted. “Within a few months of using the electronic prior authorization process, all customers using this system saw significant reductions in turnaround times, with 54% of monthly determinations not requiring authorization and 70% of prior authorization requests sent to Humana being approved immediately.

“This is due to the integration between the athenahealth system and Humana’s system, which allows for robust data collection and sharing,” she added. “These direct approvals have dramatically reduced administrative burden, contributed to shorter turnaround times, and improved access to care.”

And the new process has resulted in below-industry average denial rates compared to previous manually processed authorizations. Specifically, there was a reduction from several days to about one day, which is the industry averages ranging from days to weeks and the seven-day target established in the CMS Interoperability and Prior Authorization Final Rule.

ADVICE FOR OTHERS

“This project has provided a number of learning points that others in the healthcare sector can learn from,” Dooley said.

“First, it’s important to focus on a common goal. The stakeholders had many open, transparent discussions to agree on what the Da Vinci Standards were and how they should be implemented. Everyone had to align, share expectations, approach problems as a team, and recognize that all parties were learning.

“In addition, it’s important to agree on what’s needed up front and make sure everyone understands terminology and timelines,” she continued. “Making sure everyone understands the project can help people avoid making assumptions. When it’s time to prepare for rollout, it’s critical to identify the roles and responsibilities of each group and establish efficient ways to reach out to the right people.”

As always, analyzing the data, checking the accuracy of the data and providing full transparency on the data will build trust among all partners, she added.

“Finally, understanding the release cadence and how each organization deploys software can help prevent or reduce potential friction and deployment delays,” she concluded. “As we look to the future, we also want to improve business logic to increase data throughput and volume.”

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