This proactive strategy allows for earlier interventions, preventing unnecessary or inappropriate care before it occurs. For example, an intelligent prior authorization system might flag a planned procedure as low-value based on the patient's unique circumstances and suggest an alternative treatment that is more likely to result in a positive outcome. By catching these issues early, health plans can avoid the costs associated with low-value care and improve patient care quality.

Less paperwork, more patient care
The administrative burden of traditional UM and prior authorization processes is well-documented, with physicians and their team members spending about 12 hours each week just on prior authorizations. The onerous administrative tasks and long wait times for authorization decisions lead to frustration and burnout among providers, as well as increase the administrative expenses associated with the process. Most importantly, the time and resources spent navigating these processes can detract from what should be the provider's primary focus: patient care.
Intelligent prior authorization solutions address these issues by automating much of the prior authorization process, reducing the time and effort providers spend on authorizations by 61%. Automated systems can process routine authorizations quickly, often in real time, allowing providers to turn their focus toward their more complex cases. When utilizing this technology, providers also report being able to schedule their patients five days faster. Streamlining operations and enhancing the provider experience leads to greater satisfaction and better care delivery for the patient.

Rightly so, burnout among healthcare professionals has been a concern in the industry for years, and intelligent prior authorization solutions are helping to combat this issue by reducing providers’ administrative load. By implementing this technology, providers can spend more time focusing on patient care than on paperwork or peer-to-peer reviews, leading to improved patient-provider relationships and better health outcomes.

Aligning UM with value-based care
The shift toward value-based care (VBC) has renewed the emphasis on delivering high-quality, cost-effective care. Intelligent prior authorization assists that care decisions are driven by value rather than volume. By identifying and reducing low-value care, these systems help health plans and providers align their practices with VBC principles–prioritizing patient outcomes over the quantity of services provided.

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