As the world continues to grapple with the effects of the pandemic, clear changes are emerging for the healthcare world both in the long-term and the short-term. Payers and providers have had to get used to a remote world, quickly pivoting to telehealth and telemedicine solutions in a short span of time. One of the byproducts of this pivot has been the changes that the prior authorization process has seen during the pandemic.
Changing patient needs
With so many of us staying and/or working from home, the way patients access healthcare has completely shifted. Telehealth and telemedicine have become the norm during lockdown, but there is clear reluctance to go back to the doctor’s office even as restrictions ease. With appointments being handled online, it only stands to reason that other processes have changed to accommodate these evolving needs quickly.
From appointment to prior authorization to prescription - all of it has become electronic and remote. It’s becoming evident that patients could always change to something more convenient to them, but the impetus was never really there.
Providers are now thinking about the post-pandemic landscape, and it’s clear that the payer-provider relationship needs to be reevaluated under current circumstances. Services that have diversified at this point need to continue to that path, to ensure that patients receive the best care possible in the ways they are most comfortable with.
Digitalizing the prior authorization process
For a very long time, the prior authorization process has been woefully behind for both payers and providers. It has been an administrative burden for payers while creating delays for patients, and its manual nature has made it difficult for each party.
We recently wrote about the upcoming improvements in the prior authorization process and that focus on creating a better patient experience on the administrative side will remain. COVID-19 accelerated changes in the prior authorization process, creating more scope for electronic approvals carried out in a more streamlined manner.
There is a growing need towards automating the prior authorization process altogether, especially in light of shifting patient needs towards remote care. The pandemic has highlighted that it is possible to move away from manual processes quickly, and prior authorization is no different.
With a more streamlined prior authorization process, payers and providers benefit immensely. There is reduced clerical and administrative burden for providers, and patients gain better access and insight into their healthcare.
As the healthcare industry continues to deal with the pandemic and its challenges, there are many areas that, if improved, can lead to a better patient experience. Prior authorization management is one of them.
With patients becoming more accustomed to receiving care online and handling other healthcare administration such as appointment-setting and prescriptions remotely, there will be greater demand for easing prior authorization.
This is already starting to gain traction, such as the U.S. Centers for Medicare & Medicaid Services (CMS) and their renewed focus on interoperability and the prior authorization process. It will be interesting to see how the pandemic further accelerates change in this space.
With increased attention on the future of prior authorization, it’s becoming apparent that automation is the way forward. Banjo Health has built a comprehensive prior authorization platform powered by artificial intelligence for both medical and pharmacy. To learn more about our prior authorization solutions and how it optimizes the process, please contact us today.