A few of our thoughts on this great read from the MIT Technology Review: "Here’s a checklist for assessing the quality and validity of a company’s machine-learning product."
Stoked about this... big news for our team and customers!
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Health insurance companies started pre authorization policies with good intentions. By asking physicians and other care providers to give detailed accounts of the treatments needed along with evidence to justify the request, the insurers could actually gain insight on treatment trends and needs that would be helpful to providers, manage costs of care delivery, and increase patient safety by reducing the risks of over-prescription or superfluous procedures.
In reality, however, pre authorization has quickly became a source of contention between the insurers and their healthcare network providers. Hospital systems and medical practices feel handcuffed from providing the best treatment to their patients by having to engage in a long and tedious administrative process, while payers feel the added oversight is essential for maintaining their operations without ballooning costs.
On the practice side, the consequences of pre authorization proliferation (54% growth in just the past 4 years) have quickly rippled throughout the industry. Physician burnout rates and administrative costs have risen while patient satisfaction are dropping precipitously. And without active assistance from the insurance providers or EHR vendors, hospitals and medical practice’s have struggled to find a comprehensive solution (beyond just adding more back office staff and incurring more costs).
This definitive guide was written to investigate the complex challenges pre authorization creates, the past attempts to mitigate these challenges, and how investment in an artificial intelligence system can eliminate 60% of the total administrative work pre authorization adds.