Health technology providers can be the intermediary that improves payer-provider relationships


It’s no secret that payers and providers have a historically adversarial relationship. This struggle was noted in KLAS’s recent “Points of Light.” reportwhich optimistically explored case studies of successful payer-provider collaborations.

After digging into case studies focused on reducing administrative burden through automation, one thing became clear: payers and providers are still struggling to collaborate effectively, but health technology providers can take action as a liaison to improve outcomes for both parties.

One such case study detailed how a health technology company olive automated the pre-authorization process for Essentia Health, based in Duluth, Minn., and Guidewell. The technology has improved the efficiency of both organizations, although Essentia Health did not work directly with any payers during this initiative, nor did Guidewell work with vendors.

Partnering with Olive allowed Essentia Health to step up to speed up the notoriously onerous pre-authorization process. Instead of pursuing direct collaborations with the multitude of healthcare system bill payers, Essentia Health chose to implement Olive’s technology, which is compatible with most payers.

When Essentia Health went live with the technology in May 2021, Olive was able to automatically display coverage guidelines for 80% of health system payers, said Jamie Madrinich, who works as a pre-service department manager. ‘Essentia Health. She said that number is now closer to 90% and that the initiative has reduced the health system’s pre-clearance turnaround time by about eight days. By eliminating much of the back and forth between staff members and payers, automation technology has freed up their time to focus on less manual tasks.

In another case study, Cedar, a healthcare payment technology company, stepped in to improve the pre-approval process at Conway Medical Center in Conway, SC, and Palmetto GBA. Similar to Essentia Health and Guidewell’s separate partnerships with Olive, Cedar’s automation technology has reduced manual labor for staff members at Conway Medical Center and Palmetto GBA.

Cedar has created a tool that links Conway Medical Center’s EMR to the software used by Palmetto GBA so that pre-authorization information can be sent and received more quickly. Automation technology has reduced the turnaround time for pre-approvals at Conway Medical Center to less than 48 hours, according to Anshul Amar, co-chief fabricator at Cedar.

“Payers and providers are really complex, multi-faceted organizations that have very elaborate business procedures,” he said. “They’ve developed their own different ways of working, so one of the ways an organization like Cedar can really bridge that gap is to allow them both to work the way they work best by connecting data and workflows.”

Companies like Cedar and Olive can often “translate” between payers and providers, Amar noted. He said that instead of a vendor completely changing their workflow based on what a payer asks them to do, health technology vendors can step in to determine how both entities can comply with each other. an effective way for their business and organizational goals. assignments.

Photo: Piotrekswat, Getty Images

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