Atlantic Health simplifies insurance authorization with intelligent automation
When the COVID-19 pandemic began, Atlantic Health System, like other healthcare providers, was under enormous stress. In addition to dealing with patients suffering from the effects of a new virus, healthcare professionals have had to contend with new care protocols, staffing issues and supply shortages caused by the pandemic, all of which have put further pressure on any existing friction. in healthcare administration processes.
The pandemic, population aging and population growth have really taken their toll on all healthcare systems, and Atlantic Health was no exception, says Sunil Dadlani, chief information and digital officer and chief cybersecurity officer at the purposeless healthcare network. for profit based in New Jersey. You combine that with the workforce shortage, the supply chain shortage, and a lot of other things that are happening.
Atlantic Health serves a population of 6.2 million people, with more than 400 centers of care, including six hospitals, and as the organization has struggled with these issues, it quickly became apparent that insurance authorization for imaging and radiology represented a critical diagnostic step before nearly all care could begin was a bottleneck. When care is urgent, delays can impact patient outcomes.
Scheduling and receiving authorization for health services has traditionally been a very complex and manual process. Each of the more than 100 radiology practices in the Atlantic Health System was responsible for its own permit applications, which required a significant investment of time and attention to administrative tasks.
Our patients come from different backgrounds and have different payers. Every payer has their own formats, their own needs, their own processes, says Dadlani. With the growing volume of radiology, he created a sense of urgency, because we were seeing more pre-authorization denials. We have seen a higher volume of additional documentation required for pre-authorisation.
To address these challenges, Atlantic Health System embarked on a project called Prior Authorization Intelligent Automation, which earned it a CIO 100 Award in IT Excellence.
Dadlani and his IT team partnered with Atlantic Health Systems’ radiology and patient access service lines to streamline the processes involved in obtaining preemptive insurance authorizations through the use of automation. The project team used intelligent rule-based analysis to identify services requiring authorization and prioritize their submission to payer portals. The automation polls payer portals for updates and retrieves authorization information without the need for a human to interact.
By expediting the process, important procedures can be scheduled before the pre-authorization process begins, meaning patients no longer have to wait to receive critical follow-up care.
Of course, with so many practices, clinicians, and team members involved in the pre-authorization process, succeeding in intelligent automation was no mean feat. First, it required standardization of pre-authorization workflows unique to its 100+ radiology practices. The operations, medical, and technology teams had to develop a new pre-approval request process, which included the creation of a new centralized pre-service team to oversee pre-approvals for the entire organization.
The creation of a new pre-service team has helped individual practices ease the administrative burden of obtaining pre-authorization and streamlined the process of training individual practices on the intelligent automation solution. The project team, working with the new pre-services team, used a series of webinars and small group sessions to help each team understand their new responsibilities and generate consensus.
For Dadlani, the key to success was starting by focusing on the business problem, not the technology.
We started by working with the right stakeholders so we could actually define the right problem, he explains. Instead of starting with automation, we started with business process.
For the IT team, this is essential because technologies and technology vendors come and go. Dadlani notes that his team is always thinking about three things: supplier update, technology update and skills update.
We’ve learned over time that there are always disruptions to our partners’ ecosystems, says Dadlani. So we constantly evaluate the business relationships we build over the years to ensure we are best placed for years to come.
Spread the success
Advance Authorization Intelligent automation has helped Atlantic Health System reduce the time it takes to submit authorizations by more than 50%, which is also 50% less than the industry average. Additionally, 70% of all clearances within the radiology service line are now handled through intelligent automation, and less than 1% of appointments are canceled due to denied or delayed clearances.
In terms of the process, it took days, says Dadlani. We’re less than four minutes away.
Dadlani is now looking for ways to extend the organization’s success in automating prior authorization for radiology services to other Atlantic Health Systems service lines, such as surgery and cardiology.
We’re not done, he says. We have collected pictures. Now we want to extend this to other areas. We have a proven use case, proven results in enterprise-wide scaling for radiology.
Dadlani recommends that technology leaders looking to implement intelligent automation in their organizations keep an open mind and be willing to fail smart, learn fast, and adapt.
Do you have a culture of collaboration and communication? This is very important, she says. You need to understand the problems or challenges your partners are facing. Your mindset should be to make them successful and solve those problems.
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