The team at Harmony Park Family Medicine in Arkansas is excited about streamlining the pre-approval process with the goal of improving patient access to high-quality care.
PROBLEM
Approval and management has historically been a cumbersome process in the industry and can cause unnecessary delays in patient care, largely due to the manual work required.
That was no different at Harmony Park Family Medicine. Provider staff spent hours each day calling, emailing, and faxing relevant demographic and clinical information needed to initiate the pre-approval process with billing organizations, often involving more back-and-forth interactions than a simple question and answer.
“We needed a way to improve the speed and transparency of the pre-approval process to reduce administrative burden and improve patient access to care,” said Yvonne Dooley, CEO of Harmony Park.
PROPOSE
Before implementation With automated electronic prior authorizations, patients often become frustrated with their providers because of the long wait times for prior authorization approvals. This can sometimes cause patients to forgo the care they need.
“Having an automated electronic pre-appraisal process reduces the administrative burden on our employees by creating an efficient process and connecting all the necessary information and requirements directly into their workflow,” Dooley explains.
“In addition to making the entire process faster and more transparent, a streamlined process would accelerate access to care, which predicts improved health outcomes,” she continued. “Furthermore, the manual nature of the pre-authorization process inevitably leads to errors that can put patient care at risk, and that was another friction point we wanted to address.”
Facing the Challenge
To automate pre-authorization, Harmony Park partnered with Humana, its billing partner; Availity, a real-time health information network; and athenahealth, the company’s EHR vendor. The three parties collaborated to develop a comprehensive electronic pre-approval process leveraging the Da Vinci Reduced Burden Implementation Guide.
“These guidelines are a set of standards designed to make the pre-authorization process more efficient and streamlined, so using them will expedite the approval of these requests and provide a comprehensive, seamless, and improved experience for patients, providers, and payers,” Dooley explains.
“By creating a seamless data exchange to connect the Humana and athenahealth platforms through Availity, data can be easily exchanged,” she continued. “Once trained on the new workflow, this direct connection allows our providers to document and sign orders to initiate pre-authorizations with all the necessary data and requirements directly in their workflow.”
This, combined with the speed and transparency that Harmony Park now provides throughout the process, eliminates the need for staff to spend hours on the phone or sending emails or faxes, significantly reducing the administrative burden on staff. This also means that patients can receive care in a more timely manner.
RESULT
The results of this collaboration were so powerful that Harmony Park won the 2024 KLAS Points of Light Award for reducing inefficiencies and improving the patient experience. Specifically, Harmony Park saw improved provider efficiency, saving staff 24 hours per week of manual work.
“Additionally, because manual pre-approval processes are eliminated on our side as well as the payer side, patients can get care that leads to improved health outcomes faster,” Dooley noted. “Within months of using the electronic pre-approval process, all customers using the system saw a significant reduction in processing time, with 54% of monthly decisions requiring no pre-approval and 70% of pre-approval requests submitted to Humana being approved immediately.
“This is due to the integration between the athenahealth system and the Humana system, which allows for robust data collection and sharing,” she added. “These instant approvals have significantly reduced administrative burden, contributing to reduced processing times and improved access to care.”
And the new process has resulted in a decline rate that is lower than the industry average compared to manually processed pre-authorizations. Specifically, there has been a reduction from multiple days to about a day, exceeding Industry averages range from a few days to a few weeks, and the seven-day target is established by CMS’s Interoperability and Prior Authorization Final Rule.
ADVICE FOR OTHERS
“There are some lessons learned from this project that others in the healthcare industry can learn from,” Dooley advises.
“First, it was important to focus on a common goal. Stakeholders had many open, transparent discussions to agree on what the Da Vinci Standards meant and how to implement them. Everyone had to adapt, share expectations, approach problems as a team, and recognize that everyone was learning.
“It’s also important to agree on what’s needed at the outset and make sure everyone understands the terminology and timelines,” she continues. “Ensuring a shared understanding of the project helps everyone avoid making assumptions. When it comes time to prepare for implementation, it’s important to define the roles and responsibilities of each team and reach the right people in effective ways.”
As always, analyzing data, checking data accuracy and providing complete transparency will build trust among all partners, she added.
“Ultimately, understanding the release cadence and how each organization deploys software can help avoid or minimize potential friction and deployment delays,” she concludes. “As we look to the future, we also want to improve business logic to increase throughput and data volume.”
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