How Advanced Technology is Supporting Prior Authorization and Reducing Delays

Key takeaways:

• Prior authorization (PA) delays in radiology can lead to significant patient care issues, including delayed diagnoses and worsened health outcomes, as well as increased costs due to the need for more complex treatments.
• Many providers are burdened with an inefficient, outdated PA process that consumes valuable time and resources, leading to burnout and strained relationships with payers.
• ImagingAssure reimagines the PA process by integrating AI-driven approvals and real-time decision support directly into provider workflows – reducing delays and improving communication and potentially leading to better patient outcomes.
  

The prior authorization (PA) process has long been a source of frustration in healthcare, particularly when it comes to imaging services. What might seem like another administrative task can delay essential imaging tests, impacting patient care and increasing stress for both providers and patients. Although many see PA as just paperwork, its impact can extend far beyond approvals.

ImagingAssure, an innovative radiology benefit management solution from Premier’s Stanson Health, addresses these challenges head-on by reimagining how PAs are handled. By streamlining workflows, ImagingAssure can help reduce delays and ensure that both payers and providers can work together more efficiently. Here’s why these delays are more than just a hassle—and how ImagingAssure can help.

The Hidden Costs of Delayed Care

In radiology, delays in PA can have severe consequences. Imaging is often a critical step in diagnosing and treating various conditions, from cancer to cardiovascular disease. When authorizations for necessary imaging tests are delayed, the consequences can be significant, leading to delayed diagnoses, worsening health conditions and increased hospitalizations. According to the American Heart Association, 33 percent of physicians report that PA issues have led to their patients experiencing a serious adverse event.

When physicians recommend imaging for their patients, timing is everything. Consider the patient’s perspective when their physician orders imaging for suspected cancer; every moment the patient waits to find out an answer is filled with anxiety, and delays can be devastating. Delayed authorizations not only impact patient outcomes, but also potentially increase the cost of care, as conditions that are not caught early become more complex and expensive to treat.

The Strain on Providers

For providers, the PA process can be a significant burden. Traditional models often require manual reviews and extensive documentation, which can slow down the entire process. Physicians and their staff spend an average of 14 hours per week on PA-related tasks. This is time that could be better spent on other medical tasks or patient care, but instead, providers are bogged down by administrative tasks that lead to burnout and dissatisfaction.

In radiology, the stakes are even higher. Imaging tests are among the most frequently targeted for PA, and the appeals process for denied requests adds another layer of complexity and frustration. According to an American Medical Association (AMA) survey, 27 percent of physician respondents indicated that PA requests were often or always denied. Radiologists often find themselves entangled in a cycle of paperwork, phone calls and follow-ups that further delay patient care and strain their relationship with payers.

How ImagingAssure Supports Radiologists and Reduces Delays

ImagingAssure is designed to tackle these challenges by streamlining the PA process and reducing the delays that can have detrimental effects. Here’s how:

1. Streamlined Workflows with Real-Time Decision Support

ImagingAssure seamlessly integrates into the provider’s existing electronic health record (EHR) system, offering real-time clinical decision support (CDS) focused on medical necessity adherence right at the point of care. This functionality empowers providers with immediate access to essential information needed to satisfy payer requirements. By delivering actionable recommendations for medical necessity adherence during order placement, ImagingAssure can help accelerate the PA process by notifying providers of documentation requirements when services require authorization and potentially reduce care delays and denials. “CDS software, like ImagingAssure, finds objective data in patients’ charts to complete PA in an automated manner. This allows clinicians to spend their time with face-to-face encounters rather than burdensome inefficient paperwork,” said Dr. Hamed Abbaszadegan, a physician executive with Stanson Health.

2. Reducing Administrative Burden

ImagingAssure leverages advanced artificial intelligence (AI) technology to automate the PA process, which can significantly help reduce the administrative burden on providers and full-time equivalents (FTEs) dedicated to PA submissions. Traditional models are often resource-intensive, requiring extensive documentation and manual oversight. ImagingAssure, however, streamlines these processes, freeing up time and resources that can be redirected to patient care, improving provider satisfaction and reducing the risk of burnout.

3. Enhancing Communication Between Providers and Payers

Effective communication between providers and payers is crucial. ImagingAssure fosters better communication by providing a transparent, collaborative platform for managing PAs with direct connection to a reliable URAC- and NCQA-accredited RBM service. This improved communication reduces the likelihood of delays and denials, helping to ensure that imaging tests are approved and scheduled promptly. ImagingAssure’s ability to facilitate seamless communication helps prevent the bottlenecks that often occur in traditional processes. “ImagingAssure is a game changer in terms of collaboration between providers and payers. The enhanced communication and automated approvals make the process smoother for everyone involved,” said Dr. Abbaszadegan.

4. Better Outcomes for Patients

Ultimately, the goal of ImagingAssure is to improve patient outcomes by helping to ensure that imaging services are delivered in a timely and efficient manner. By reducing PA delays, ImagingAssure helps prevent the worsening of conditions that rely on timely imaging for diagnosis and treatment. This can lead to better health outcomes and a more positive patient experience, as patients receive the necessary care without the stress of prolonged uncertainty.

Final Thoughts

For providers, PA delays are far more than just an administrative hassle—they can have real, tangible effects on patient care, provider satisfaction and the overall efficiency of the healthcare system. The emotional, financial and operational impacts of these delays are particularly pronounced in radiology, making it essential to find solutions that streamline the process and reduce unnecessary hold-ups.

ImagingAssure offers a way forward by rethinking the PA process from the ground up. By automating approvals, enhancing communication and reducing administrative burdens, ImagingAssure not only helps to mitigate the negative effects of delays, but also fosters a more collaborative and efficient healthcare environment.

In a field where every minute matters, ImagingAssure helps ensure that patients receive the imaging services they need when they need them, enabling a transformed PA process from a frustrating obstacle into a seamless, supportive part of the healthcare journey.

For more on this topic:

• Learn more about how Stanson Health can help you streamline the PA process
  

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