By using a badass two-sided platform, we can finally kick healthcare’s ass and solve the damn problem with prior authorization. This shit has been a hot topic in the industry, with everyone trying to come up with fancy technology solutions to fix this inefficient and frustrating process. But let me tell you, those so-called fixes are just a drop in the bucket, my friend. We need a whole new solution.
Prior authorization is a damn nightmare that causes burnout and frustration. Health plans use it to make sure doctors are practicing evidence-based care, but it’s creating a huge rift between payers and providers. Trust me, there’s no trust in this messed-up system.
So, here’s what we need to do. We need to create a badass health information network specifically for prior authorization. Just like we built a national network for e-prescribing, we need to build one for PA. That’s the only way we’re gonna fix this shit and address the lack of visibility and transparency that’s at the heart of all these damn PA problems.
Now, let’s talk about trust. Both payers and providers have valid points when it comes to PA. Doctors and patients think it’s a pointless bureaucratic hurdle that gets in the way of providing timely care. Payers, on the other hand, see it as a way to control costs and prevent unnecessary treatments. They don’t trust that doctors are making the right decisions for patients because they have no visibility into the care process.
And you know what? They’re not wrong to feel that way. The amount of medical knowledge is growing at an insane rate, making it impossible for doctors to keep up. Plus, there’s a ton of variation in care from one institution to another. So, it’s no wonder providers don’t trust that payers are putting patients before profits.
But here’s the thing. We can’t just rely on proposed standards or fancy technology to fix this shit. We need a whole new approach. Sure, gold cards and value-based care might help in some ways, but we need something completely different to fix this on a large scale.
Unfortunately, the latest policy proposals are just causing confusion and making things worse. The information exchange standards they’re pushing don’t address the variation and meaning of the data being exchanged. It’s a hot mess, my friend.
But there is some innovation happening in the PA space. AI is being embraced as a potential solution, with companies like Google, Microsoft, and IBM jumping on board. They’re using generative AI to automate manual tasks and make the PA process more efficient.
Even Premier, a big player in the healthcare industry, is tackling prior authorization. They’ve acquired a company called Stanson Health, which provides clinical decision support tools integrated into EHR systems. They’re trying to make PA a part of the workflow, instead of an annoying afterthought.
Health plans are also getting in on the AI action. Blue Shield of California is working with Google Cloud to speed up the PA process using AI and machine learning. But let’s not forget, humans still play a crucial role. AI is just a tool, not the answer to everything.
So, there you have it. Prior authorization is a pain in the ass, and we need a whole new approach to fix it. We need a dedicated health information network, more trust between payers and providers, and some badass technology to make it all happen. It won’t be easy, but I believe we can kick some serious ass and make this shit work.