AI-Powered Prior Authorization: A New Era with Salesforce Health Cloud

In the ever-evolving healthcare industry, efficiency and patient care are crucial. Streamlined processes ensure that patients receive timely and appropriate care, reducing the risk of complications and improving overall health outcomes. At the same time, a strong focus on patient care fosters trust and satisfaction, which are essential for successful treatment and recovery. 

Recognizing these imperatives, a leading health organization and Salesforce have embarked on a groundbreaking partnership to streamline the prior authorization process. This collaboration aims to address one of the most significant pain points in healthcare: the often cumbersome and time-consuming approval process for medical treatments and services. 

The Challenge of Prior Authorizations 

Prior authorizations are essential for ensuring that treatments are safe, evidence-based, and cost-effective. However, the traditional process is fraught with inefficiencies, often leading to delays in patient care. According to a survey by the American Medical Association, 78% of physicians reported that issues with prior authorizations can result in patients foregoing necessary treatments. 

This is in part due to outdated and inefficient healthcare industry processes, where about two-thirds of prior authorization requests are submitted manually or partially manually, including by fax machine. Submissions that lack complete clinical information slow the process, and outdated electronic systems waste time and resources, leaving patients without answers and worried about their next steps in care. 

A Technological Solution 

Leveraging Salesforce Health Cloud, this partnership is set to transform the prior authorization process. Health Cloud integrates with existing electronic health records (EHRs) to gather relevant clinical data, enabling near real-time prior authorization decisions. 

The use of Health Level Seven (HL7) Fast Healthcare Interoperability Resources (FHIR) standards creates technology that will streamline over 20 different systems into one process that integrates with physicians’ current workflow. 

The Role of AI 

AI plays a crucial role in this transformation. By automating data collection and analysis, AI can significantly speed up the approval process. This not only reduces the administrative burden on healthcare providers but also ensures that patients receive timely care. The AI system is designed to handle most requests quickly, with only a small number requiring further clinical consultation. 

When clinical consultation is needed, physicians will receive a message in near real-time detailing what is needed to complete the authorization and options to begin a peer-to-peer clinical consultation. This process, which currently can take several days, will be reduced to hours, depending on the requesting physician’s availability. 

Benefits for Patients and Providers 

Patients will receive updates on their authorization status through a member app, giving them more clarity around their status. 

For providers, the streamlined process allows them to focus more on patient care rather than administrative tasks. Modifications or denials will always be made by a medical director or licensed clinician, ensuring that decisions are clinically sound. 

A Step Towards Digital Transformation 

This partnership is a testament to the power of digital transformation in healthcare. By adopting advanced technologies, the collaborators are setting a new standard for efficiency and patient care. This initiative not only addresses current challenges but also paves the way for future innovations in healthcare delivery. 

Ready to Transform Your Healthcare Organization? 

This prior authorization solution using Health Cloud and AI is a significant step toward a more efficient and patient-centric healthcare system. As we continue to navigate the complexities of healthcare, such partnerships highlight the potential of technology to drive meaningful change. 

At Perficient, we are excited to see how these advancements will shape the future of healthcare and are committed to supporting our clients in their digital transformation journeys. 

Whether you’re looking to enhance patient engagement, streamline operations, or leverage data for better decision-making, we’re here to guide you every step of the way. From initial strategy to implementation and ongoing support, Perficient is committed to helping you achieve your healthcare transformation goals. 

Don’t let outdated systems hold your organization back. Take the first step towards a more efficient, patient-centric future. Contact Perficient today to discover how we can help you harness the power of Salesforce and other leading technologies to revolutionize your healthcare delivery. 

Let’s work together to create healthier communities and better patient outcomes. Reach out now to start your transformation journey with Perficient. 

 

Source: Read More