Why Haven't Payers Automated Prior Authorizations Previously?

Episode 217 of the Healthcare IT Today Interviews podcast, hosted by John Lynn, titled "Why Haven't Payers Automated Prior Authorizations Previously?" was published on April 26, 2022 and runs 20 minutes.

April 26, 2022 ·20m · Healthcare IT Today Interviews

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Summary

One of the banes of healthcare is prior authorizations.  Just mention of the phrase makes the hearts of doctors and their staff break.  While every doctor and medical staff I know hate prior authorizations, the payers have a good reason for them.  They want to make sure they're paying for the proper care.  It's a tough balance that we certainly haven't figured out yet and so many practices are stuck on the phone waiting to get the prior authorization so they can provide the care that's needed.  Turns out.  No one likes the current process.  Payers or providers.  Why then haven't we automated the prior authorization process?   Well, GuideWell and Olive recently announced a pilot where they're working to do just this.  I sat down with Tina Cummings, VP of Clinical Operations and Performance at GuideWell, and Dr. Jeremy Friese, President of Payer Market at Olive, to dive into the project they're doing together to automate prior authorizations.  Their experience with this pilot gives us a better understanding of what it's going to take to automate prior authorizations.  The pilot started with just one specialty, but has shown promising results for both the payer and the practice.  From the payer perspective, they are able to ensure that proper care guidelines are being followed.  It turns out that a large portion of the prior authorizations can be automated with the right documentation since most doctors are doing the right thing.  From the practice perspective, it's amazing to have many of your prior authorizations automatically approved.   Check out the interview to learn more about this prior auth pilot and why GuideWell was interested in automating prior authorizations, the technology they needed to automate the process, the challenges they faced, and why they're now working to roll this out more broadly.   Learn more about GuideWell: https://www.guidewell.com/  Learn more about Olive: https://oliveai.com/  Find more great Health IT content: https://www.healthcareittoday.com/

Episode Description

Well, GuideWell and Olive recently announced a pilot where they're working to do just this. I sat down with Tina Cummings, VP of Clinical Operations and Performance at GuideWell, and Dr. Jeremy Friese, President of Payer Market at Olive, to dive into the project they're doing together to automate prior authorizations. Their experience with this pilot gives us a better understanding of what it's going to take to automate prior authorizations. The pilot started with just one specialty, but has shown promising results for both the payer and the practice. From the payer perspective, they are able to ensure that proper care guidelines are being followed. It turns out that a large portion of the prior authorizations can be automated with the right documentation since most doctors are doing the right thing. From the practice perspective, it's amazing to have many of your prior authorizations automatically approved.

Check out the interview to learn more about this prior auth pilot and why GuideWell was interested in automating prior authorizations, the technology they needed to automate the process, the challenges they faced, and why they're now working to roll this out more broadly.

Learn more about GuideWell: https://www.guidewell.com/

Learn more about Olive: https://oliveai.com/

Find more great Health IT content: https://www.healthcareittoday.com/