Healthcare Provider Interface for Prior Authorization Automation
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Solution Overview
Problem
Current healthcare systems face inefficiencies in prior authorization processes for medications and treatments, leading to significant time burdens for physicians and abandoned treatments due to lack of patient-specific optimization and lengthy approval times, with electronic prior authorization procedures often failing to address these issues effectively.
Innovation Solution
A healthcare provider interface with a graphical user interface that collects patient demographic, physiological, and insurance information to generate a tailored list of medication options and prior authorization forms, streamlining the authorization process by integrating input and output pages for efficient data entry and review.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Extent of automation
If electronic prior authorization procedures are implemented, then the authorization process can be digitized and tracked, but patients still experience long waiting times (64% wait a day, 30% wait longer than a day)
Solution Approach 1:
The system performs preliminary actions by pre-populating prior authorization forms with patient demographic information, physiological data, insurance details, and treatment history before the provider needs to submit the request. This advance preparation significantly reduces the time required to complete authorization during actual treatment needs.
Solution Approach 2:
The interface enables self-service functionality where the system automatically generates treatment lists based on patient data, pre-fills authorization forms with relevant information, and streamlines the submission process without requiring extensive manual intervention from providers or administrative staff.
2Extent of automation
If current ePA procedures are used, then prior authorization can be processed electronically, but the procedures are not tailored to specific patients and result in non-optimal medical care
Solution Approach 1:
The system applies local quality by customizing the prior authorization process for each individual patient. It generates patient-specific treatment lists based on unique demographic, physiological, and medical history data, and tailors the authorization forms to reflect individual patient needs rather than using generic templates.
Solution Approach 2:
The system performs preliminary analysis of patient-specific data including demographic information, physiological measurements, insurance coverage details, and past treatment responses to pre-generate personalized treatment recommendations and populate authorization forms with patient-relevant information before submission.
3Ease of operation
If physicians manually handle prior authorization matters, then they can review and submit requests, but they spend 10-20 hours per week on this administrative task
Solution Approach 1:
The interface implements self-service by automatically generating treatment lists from patient data, pre-populating prior authorization forms with all relevant patient information, and enabling one-click submission. This eliminates the need for physicians and staff to manually compile and submit authorization requests, freeing up 10-20 hours per week for patient care activities.
Solution Approach 2:
The system merges multiple separate tasks into a single integrated workflow: patient data review, treatment selection, form completion, and authorization submission are combined into one unified interface that handles all steps automatically, reducing the time and effort required for prior authorization.
4Adaptability or versatility
If prescribers select treatments without knowing prior authorization requirements, then they can choose optimal patient care, but approximately one third of prescriptions requiring prior authorization are abandoned
Solution Approach 1:
The interface provides immediate feedback to prescribers during treatment selection by indicating which medications or procedures require prior authorization. This real-time information allows physicians to make informed decisions about treatment options that balance patient needs with authorization requirements, reducing abandonment of prescriptions.
Solution Approach 2:
The system performs preliminary checks to identify which selected treatments require prior authorization before the physician finalizes the prescription. This advance notification allows providers to adjust treatment selections or prepare authorization requests proactively, preventing abandonment of necessary medications.
Data Source
AI summary
A healthcare provider user interface for treatment option and authorization is disclosed herein. In embodiments, a healthcare provider interface includes a display coupled to one or more processors. The display includes a graphical user interface comprising one or more input interface display pages and one or more output interface display pages. The one or more input interface display pages may include one or more fields configured to receive information including patient demographic and physiological information, insurance information, past treatments, and one or more medical diagnoses. The one or more output interface display pages may include a treatment list generated based on the received information and a prior authorization output.