The American healthcare system is stretched dangerously thin. The global pandemic forced hospitals and private practices to care for more patients with fewer staff. One immediate action that can produce instant results is to streamline time-consuming administrative work, including repetitive administrative tasks associated with prior authorizations. We talked with Lisa Hebert, an expert in the field, about the burden of prior authorizations on clinicians and healthcare organizations and how this burden can be alleviated.  

Read on to learn more about what Hebert thinks can be done to improve this part of the healthcare process.  

Future Healthcare Today (FHT): How has the COVID-19 pandemic changed the healthcare system and the pressures on clinicians? 

Lisa Hebert (LH): For clinicians, the pandemic is still not over yet since we still do not know what the long-term effects of COVID will be. The pandemic has changed the way in which clinicians treat patients, the information that is available to them is always shifting. The care setting, the structure of clinical visits, and the way that day-to-day activities are divided within the provider offices have all been altered as a result of the multitude of policies and procedures that have been implemented for COVID. 

FHT: How does administrative work add to the challenges for clinicians? 

LH: The patient care process can be slowed down by administrative work. Clinicians want to make sure that their patients can be seen quickly and that they are receiving the best care, but administrative and manual tasks can create more work – leading to delays in their patient’s care. Additionally, the majority of provider offices have staff members whose sole responsibility is to assist with administrative procedures, which adds to the amount of money and time spent managing the business of healthcare. 

FHT: What is one of the most burdensome areas? 

LH: One of the most time-consuming and laborious aspects of administrative work are prior authorizations – they are a hardship for both the provider and the payer. Because many processes for prior authorizations are still dependent on manual entries, such as faxes, and that there is limited to no automation of workflows across the industry, it’s challenging to determine when exactly authorization is required. In addition, the regulations regarding prior authorizations are a moving target, which means that healthcare providers and payers alike are monitoring how to manage and integrate complex technologies. The provision of medical care may ultimately be slowed down as a result, which is why widespread adoption of the standards and the push to interoperability are so crucial. 

FHT: How can this burden be alleviated? 

LH: The implementation of electronic workflows will be a game-changer and will aid in the alleviation of the stress caused by prior authorizations. Automation gives clinicians the ability to effortlessly retrieve information from patient charts and easily prepopulate forms, which speeds up the authorization process and allows them to provide patient care more rapidly. In the near future, there will be regulatory changes that will assist in making prior authorizations more streamlined. This will ensure that there is no delay in care and that patients receive a high level of evaluation, expectations, and treatment. 

FHT: Any last thoughts to share? 

LH: Within the workflow of the prior authorization process, there is a tremendous possibility for artificial intelligence (AI) and machine learning (ML) to help get approvals issued more quickly. The burden on providers would be greatly reduced, and payers would benefit since they would be able to reallocate the expensive clinical teams they have, leaving the less complicated cases to be handled by AI models where they can be automatically evaluated. This will result in a shift in the distribution of the burden on both the payer and the provider sides, with the clinical teams taking on greater responsibility for the more intricate aspects of the work. It is quite thrilling to see AI come around in the industry; it will undoubtedly be a significant change. 

Lisa Hebert is the Senior Director of Product Management at NantHealth, where she leads the product management team for NaviNet, a leading payer-provider collaboration and engagement platform.