Digital Collaboration Maximizes Efficiency and Reduces Congestion in the Healthcare Ecosystem

The cost and scope of inefficiencies in the U.S. healthcare system are enormous. 

CBS reports that excessive financial waste in our healthcare system ranges from $760 billion to $935 billion per year - that's more than the total for annual federal defense spending. The largest portion of this excess is administrative activities; these tasks required of physicians, their staff, and nurses are complex and devour so much time that they waste hundreds of billions of dollars each year. 

To add to the bureaucratic labyrinth, a data analysis conducted by the National Library of Medicine found that more than half of the patients surveyed were not properly informed when it came to understanding the intricacies of their health insurance, even on the most basic level. Among a host of problems this creates, a central obstacle is how it limits the ability of patients to advocate for themselves. The multi-layered process is difficult to understand, and patients are consistently barraged by an abundance of unintelligible information and excessive tasks. These circumstances emphasize the important need to better address and improve our healthcare delivery system efficiencies. 

A systematic change is needed to put everyone on the same wavelength. 

The Emergence of Digital Solutions

Data and digital technologies have converged with medicines, electronic devices, and healthcare diagnostics to create a new market - as well as opportunities for improved efficiencies - for healthcare delivery. This surge in data accumulation and processing power represents a transformational opportunity for healthcare to become more precise, predictive, personalized, and convenient.

While advances in medicine, regulations, and medical technology ultimately lead to better care for patients, they create a maze of complex medical policy guidelines and standards that payers, providers, and patients must navigate. 

A particular point of congestion is the bottlenecks created for the prior authorization process, which is designed to ensure that payers are paying for covered, medically necessary treatment. Recognizing and confirming prior authorizations can be a logistical struggle and impede patient outcomes. 

An AMA report states that 94% of providers report delays in care due to delays in the prior authorization process, and 79% say that their patients have abandoned seeking treatment altogether due to issues with authorizations. In addition, many providers have reported adding additional full-time staff to focus solely on navigating the entire process.

As we move into 2023 and beyond, digital tools have emerged as a strategically significant solution for a more effective and future-oriented healthcare workforce. New advancements in integrated value-based technology make it possible to seamlessly communicate across a flexible, extensible platform and facilitate provider engagement, providing trustworthy actionable data throughout the continuum of care delivery.  

Streamlining the prior authorization process, for example, can relieve burdens, giving providers and patients confidence that they are receiving appropriate care at the right time, and ensuring that the patient won't be left to cover the bill for non-authorized treatments. 

A user-friendly, multi-payer portal enables real-time exchange of authorization submission requests between health plans and providers without requiring additional labor. This tech provides access to up-to-date information regarding authorization status updates and automates workflows to streamline data exchange/storage. Building trust between providers and payers and optimizing patient care shifts authorizations from a costly and time-consuming manual process to a simplified online submission with digitized tracking.

Collaborative platforms help providers spend less time capturing information from various unstructured sources, thus reducing the need to sift through multiple reports to get a holistic and complete picture of the patient. New and innovative solutions enhance workflows with instant access to eligibility and benefits. This, in turn, eliminates time-consuming administrative tasks, repetitive phone calls, and paper claims. Instead, it serves to consolidate the authorization process and allow providers to access the most current authorization information spanning status updates, approvals, or denials. It also automatically requests any additional information and streamlines applications for the exchange of documents related to clinical, financial, and administrative information in real time. 

The healthcare industry as a whole has an opportunity to receive a number of tangible, applicable, and worthwhile benefits from adopting digital solutions; these enhancements eliminate unnecessary, often manually related workloads, not only saving time but also conserving resources. In addition to maximizing available logistics, this helps increase the valuable time a patient can spend with their physician. 

Payers and providers need tools to better communicate with one another. Platforms are emerging as a valuable, practical, and much-needed solution. This enhanced technology manages data, guides decisions, and ultimately helps deliver better patient care. Payer and provider collaboration generates trustworthy data throughout the continuum of the healthcare journey, placing patients in a prime position to receive quality and affordable treatment in a way that is easy for them to receive, digest, and process. This type of platform targets logistical pain points and eliminates cumbersome bottlenecks that prevent all-concerned parties from realizing maximum capability. 

The Benefits for Everyone

Overall, a digitally collaborative platform gives payers and providers the benefit of increased operational efficiency, streamlined communication, and significant savings. It reduces manual processes and decreases administrative complexities, which will increase transparency, facilitate engagement, and generate a trustworthy and actionable continuum of care delivery. When the processes are working in the most efficient way for the payer and provider, it is beneficial to all stakeholders in the healthcare ecosystem and - most importantly - is beneficial to the patient's care and health results. 

Lisa Hebert is the Senior Director of Product Management at NantHealth, where she leads the product management team for NaviNet, a leading payer-provider collaboration and engagement platform. Under her leadership, Hebert has expanded the product portfolio and introduced new capabilities that enhance and promote greater administrative efficiencies for payers and providers. 

Prior to joining NantHealth in 2016, Hebert was the Director of Product Management for Highroads, Inc., a start-up focused on payer SaaS offerings to enable sales and marketing teams self-service workflows aimed at speeding up the sales cycle and meeting ACA mandates for timely and accurate plan benefit information. Over her 20-year career, Hebert has held several product and project management roles in the healthcare industry, including Tufts Health Plan, Best Doctors (now Teledoc), and Caritas Christi Healthcare. Hebert holds a Bachelor of Arts degree in Communications from Westfield State University.