It is no secret that payers and providers have historically been antagonistic. This struggle was noted in KLAS’ recent “Points of Light” Reportwhich optimistically explores case studies of successful payer-provider partnerships.
After delving into case studies focused on reducing administrative burden through automation, one thing becomes clear: Payers and providers still struggle to collaborate effectively, but medtech vendors can act as connecting brokers to improve outcomes for both parties.
One such case study details how a health tech company olives Automates the prior authorization process in Duluth, MN Essentia Health and pilot well. The technology improved the efficiency of both organizations, although Essentia Health did not work directly with any payers during this program, nor did Guidewell work with providers.
Partnering with Olive enables Essentia Health to handle matters on its own to expedite the notoriously burdensome prior authorization process. Instead of working directly with the numerous payers of health system bills, Essentia Health chose to implement Olive’s technology that is compatible with most payers.
When Essentia Health turns on the technology in May 2021, Olive will be able to automatically pull coverage guidelines for 80 percent of the health system’s payers, said Jamie Madrinich, a former division manager of services at Essentia Health. That figure is now close to 90 percent, she said, and the move has reduced the health system’s turnaround time for prior authorization by about eight days. By eliminating a lot of back and forth between employees and payers, automation technology frees them up to focus on less manual tasks.
In another case study, cedarA company focused on healthcare payment technology stepped in to improve the prior authorization process at Conway Medical Center in Conway, South Carolina, and the Palmetto Greater Bay Area. Similar to Essentia Health and Guidewell’s separate collaboration with Olive, Cedar’s automation technology can reduce manual tasks for Conway Medical Center and Palmetto GBA staff.
Cedar created a tool to link Conway Medical Center’s EMR with software used by Palmetto GBA, allowing for faster sending and receiving of prior authorization information. Anshul Amar, co-lead manufacturer of Cedar, said the automated technology reduced Conway Medical Center’s pre-authorization turnaround time to less than 48 hours.
“Payers and providers are very complex, multi-faceted organizations with very complex business processes,” he said. “They’ve evolved their own different ways of working, so one of the ways organizations like Cedar can really bridge that gap is to get them all to work at their best, by bridging data and workflow.”
Amar noted that companies like Cedar and Olive can often “translate” between payers and suppliers. Rather than the provider completely changing its workflow at the behest of the payer, he said, medtech providers can intervene to find out how the two entities can comply with each other in a way that works for their business goals and organization. Task.
Photo: Piotrekswat, Getty Images
