Can Health Plans save $100M annually AND reduce provider friction from Prior Authorizations?

Today while preparing for our webinar Using AI to Automate Prior Authorization Processing (October 28 @ noon CST – Register HERE) I re-read the CAQH 2019 Index. CAQH does a great job with their yearly index and deserve a shout out here. Several quotes from the report jumped out at me:

Prior Authorization Friction

“prior authorization is the costliest and most time-consuming transaction to conduct manually”

“Electronic prior authorization adoption remained low relative to other administrative transactions”

“Prior authorization continues to be a growing challenge for 9 out of 10 physicians”

“The medical industry could save… $454 million annually” through automation.

Prior Authorization is costly, time-consuming and challenging. The Prior authorization clearly creates process friction for all involved; patients, members, employees, providers, plans, specialists and many others.  

Quantifying PA Friction

I started my career in accounting so I am always interested in the numbers and other data that can help quantify the process friction with prior authorizations.  CAQH also has some revealing quotes:

“Potential Average Time Savings for Medical Industry (per transaction): 17 Minutes”

“Number of 2019 PA transactions (Manual or Partially Electronic): 159 million”

“$454 million annual savings opportunity for payers and providers”

Clearly the data points to impressive savings if prior authorizations are automated.

A Vision for a Frictionless Process

In my previous post Can Software read Prior Authorizations, I argued that it shouldn’t require an act of Congress to get electronic prior authorizations, but it actually will require just that. Considering how dysfunctional our Congress is these days, changing the law is unlikely.  Given that, what should our vision be today?  Here is what I propose:

Let’s make Prior Authorizations as easy as possible for providers.  Let’s not require them to invest in new technologies while their budgets are strained and IT resources are scarce. The fax is not great, but it is the closest thing to interoperability we have right now.  Let providers keep their fax workflows as they are.  Let’s use existing Intelligent Capture, Artificial Intelligence and Workflow technologies to automate the process as best we can to reduce friction, costs and provider unhappiness, TODAY!

Reducing Risk with a Proof of Concept Project

One “technology” we have at our disposal today is the Proof of Concept (POC) Project. Let’s use it to prove that we can automate faxes at health plans to make prior authorizations faster, cheaper and easier for all involved. Virtually every project we take on at BRYJ involves a POC. We created the PA Innovation Proof of Concept project (IPOC) to prove that PA automation is a reality today.  The IPOC is a 30-day project to test your PA documents with Intelligent Capture software. We offer the IPOC in a short timeframe and at a low cost to show you what is possible in just 30 days.  The technology works, the PA Innovation POC simply proves it to you, with your documents, before you invest in a complete system.

Schedule a Call

If you would like to learn more about the BRYJ Innovation POC for Prior Authorizations, please reach out to me at mike@bryjinc.com. Thanks.

Mike Hurley is co-founder and President of BRYJ, Inc. BRYJ, Inc. is a consulting and systems integration firm on a mission to help organizations with intelligent capture and digital transformation. Our team has been helping companies digitize their processes since 1997. You can follow Mike on Twitter @BryjMike or connect with him on LinkedIn here.