Sally Ragab, CEO @Neunetix.
All healthcare providers, pharmacists and patients in the United States are afraid to say or hear “pre-authorized permission is required for that.” Advance approval is a bottleneck that delays care, irritates staff and awaits patients.
Pre-approval is a cost control process that has been implemented for reasons. It guarantees that your doctor or other healthcare provider will be refunded by your insurance company for costly procedures. Insurance companies want to protect their profits and process claims for less patients. All these steps are introduced to ensure that patients really need expensive treatments or medications. However, as more guardrails rise, it becomes difficult for providers to provide care or receive care.
Research by the American Medical Association found that prior approval or delayed and disrupted care “has become a predictable and disastrous part of the patient's experience” and “has negatively affected the delivery of necessary medical care, putting quality care at risk and harming patients.” According to the study, over 90% of physicians reported that prior permission had a negative impact on patients' clinical outcomes. On average, doctors fill out 43 prior approvals per week, almost a quarter of which are rejected.
I think modifying this process is not just an operational adjustment, but one of the fastest ways to improve healthcare delivery in the US. This is a simple, intensive intervention that can instantly reduce management costs, speed up care and improve outcomes, especially for patients with chronic or life-threatening conditions.
Automatic hesitancy
Historically, when it comes to automating manual processes, we often feel hesitant. It takes time for providers and patients to trust new technologies. When you've done something in a certain way for a long time, it's often hard to believe there's a better way. If so, why not use it? Healthcare conflicts against several industry challenges that make changing systems difficult.
•Regulatory and Compliance Challenges: Healthcare is heavily regulated (e.g. HIPAA, GDPR), and automation solutions must meet strict privacy and security standards and complicate implementation and integration.
• Data Interoperability and Quality: Fragmented systems and inconsistent data formats make it difficult to create seamless automation across the platform. Furthermore, low quality or incomplete data can interfere with the effectiveness of automation tools.
• Workflow integration: Healthcare professionals may resist automation as concerns about established workflow disruptions, as it becomes a critical barrier to user acceptance and proper integration.
•Ethical, Accuracy, Security Concerns: Healthcare automation involves high risks related to patient safety, ethical decision-making and cybersecurity. Ensuring reliable, accurate systems and maintaining data security is a critical issue.
All of these concerns are valid. However, building trust and implementing new ideas takes time. Automation is not about replacing staff. It's about giving providers and staff the tools they need to move faster, smarter, and more confidently.
Time to purify documents
We are a key moment in healthcare. Staffing, burnout and rising costs have forced us to rethink how our organization operates. It's time to say goodbye to the manual process.
Modifying prior approval is just the beginning. By automating and streamlining this process, you gain leverage to optimize other processes. The same technologies (AI, AI, and smart routing) can improve revenue cycle management, inventory management, patient onboarding, treatment planning, and insurance claim submissions.
By removing friction from the management process, we can free the clinical and pharmacy teams to make counselling patients, coordination of care, catching errors and ultimately treating patients more quickly.
The best technology not only automates tasks, but also redefines human roles. This is a way to change the conversation from “how to catch up with the documents.” “How can I prevent patients from slipping through the cracks?”
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