You may love him. You may hate him. But when the person who’s set to lead the agency running the nation’s biggest healthcare programs talks about prior authorization, we definitely want to pay attention.
"When I sat with Senator Wyden last night, he asked about a similar issue, which is pre-authorization. We spend about 12% of the CMS budget on bureaucratic processes, the administration of the program, and most of that money is taken by middlemen, in ways that I don't think need to be true in the long term.
I believe we have the power right now, with technology that didn't exist even three or four years ago, to automate a lot of these processes, and pre-authorization's a good example. There are about 15,000 procedures that go through pre-authorization. Insurance companies, in aggregate, probably have 5,000 they'll list, but they only have to have about 1,000 in order to truly make a difference and make sure that the right procedures are done in the right way.
We should be able to create an experience for physicians and patients that we know almost immediately if what they are going through is requiring a pre-authorization, and if it does, what do they actually do to qualify for it. That could be instantaneous. By doing this rapidly, we'd cut out several percent of administrative cost, deal with the intense frustration the American people have, with pre-authorization, which was raised by many members of this committee, and we actually improve the care of people without costing or taking money out of the system. Those are the kinds of advances I believe we can champion."
SamaCare is a testament to the fact that automation can reduce time spent on prior authorizations. On average, medical practices using SamaCare to streamline and automate prior authorization submission, tracking, and renewals cut time spent by practice staff on prior authorizations in half.
What's more, automation can help reduce delays associated with prior authorization time to resolution. Practices who use SamaCare see an average turnaround time reduction of 84% by:
The goal of bringing transparent requirements to the prior authorization process is noble – but complex. Different payers require different documentation, have different policies around step therapy, different preferred formularies, even different processes for submitting a prior authorization. Even within the same payer, two different health plans may have completely different prior authorization policies for the same drug or procedure. SamaCare has observed firsthand the impact of these inconsistencies on patient access: we’ve seen denial rates for the same treatment range from 0-50%+ across different payers and plans.
While the goal of making these policies transparent is noble, healthcare providers will attest to the fact that inefficient processes and inconsistent policies make this very challenging – sometimes, the only way to optimize a prior authorization is through experience. These nuances require technology that not only automates the process, but also leverages AI to learn from disparate data sources on prior authorization approval and denial rates, denial reasons, etc. in order to proactively help practices navigate the prior authorization process. Transparency cannot exist without the technology to unify, interpret, and augment prior authorization data.
In our view, Dr. Oz was right about the changes that need to happen for prior authorizations:
You may love him. You may hate him. But when the person who’s set to lead the agency running the nation’s biggest healthcare programs talks about prior authorization, we definitely want to pay attention.
"When I sat with Senator Wyden last night, he asked about a similar issue, which is pre-authorization. We spend about 12% of the CMS budget on bureaucratic processes, the administration of the program, and most of that money is taken by middlemen, in ways that I don't think need to be true in the long term.
I believe we have the power right now, with technology that didn't exist even three or four years ago, to automate a lot of these processes, and pre-authorization's a good example. There are about 15,000 procedures that go through pre-authorization. Insurance companies, in aggregate, probably have 5,000 they'll list, but they only have to have about 1,000 in order to truly make a difference and make sure that the right procedures are done in the right way.
We should be able to create an experience for physicians and patients that we know almost immediately if what they are going through is requiring a pre-authorization, and if it does, what do they actually do to qualify for it. That could be instantaneous. By doing this rapidly, we'd cut out several percent of administrative cost, deal with the intense frustration the American people have, with pre-authorization, which was raised by many members of this committee, and we actually improve the care of people without costing or taking money out of the system. Those are the kinds of advances I believe we can champion."
SamaCare is a testament to the fact that automation can reduce time spent on prior authorizations. On average, medical practices using SamaCare to streamline and automate prior authorization submission, tracking, and renewals cut time spent by practice staff on prior authorizations in half.
What's more, automation can help reduce delays associated with prior authorization time to resolution. Practices who use SamaCare see an average turnaround time reduction of 84% by:
The goal of bringing transparent requirements to the prior authorization process is noble – but complex. Different payers require different documentation, have different policies around step therapy, different preferred formularies, even different processes for submitting a prior authorization. Even within the same payer, two different health plans may have completely different prior authorization policies for the same drug or procedure. SamaCare has observed firsthand the impact of these inconsistencies on patient access: we’ve seen denial rates for the same treatment range from 0-50%+ across different payers and plans.
While the goal of making these policies transparent is noble, healthcare providers will attest to the fact that inefficient processes and inconsistent policies make this very challenging – sometimes, the only way to optimize a prior authorization is through experience. These nuances require technology that not only automates the process, but also leverages AI to learn from disparate data sources on prior authorization approval and denial rates, denial reasons, etc. in order to proactively help practices navigate the prior authorization process. Transparency cannot exist without the technology to unify, interpret, and augment prior authorization data.
In our view, Dr. Oz was right about the changes that need to happen for prior authorizations:
You may love him. You may hate him. But when the person who’s set to lead the agency running the nation’s biggest healthcare programs talks about prior authorization, we definitely want to pay attention.
"When I sat with Senator Wyden last night, he asked about a similar issue, which is pre-authorization. We spend about 12% of the CMS budget on bureaucratic processes, the administration of the program, and most of that money is taken by middlemen, in ways that I don't think need to be true in the long term.
I believe we have the power right now, with technology that didn't exist even three or four years ago, to automate a lot of these processes, and pre-authorization's a good example. There are about 15,000 procedures that go through pre-authorization. Insurance companies, in aggregate, probably have 5,000 they'll list, but they only have to have about 1,000 in order to truly make a difference and make sure that the right procedures are done in the right way.
We should be able to create an experience for physicians and patients that we know almost immediately if what they are going through is requiring a pre-authorization, and if it does, what do they actually do to qualify for it. That could be instantaneous. By doing this rapidly, we'd cut out several percent of administrative cost, deal with the intense frustration the American people have, with pre-authorization, which was raised by many members of this committee, and we actually improve the care of people without costing or taking money out of the system. Those are the kinds of advances I believe we can champion."
SamaCare is a testament to the fact that automation can reduce time spent on prior authorizations. On average, medical practices using SamaCare to streamline and automate prior authorization submission, tracking, and renewals cut time spent by practice staff on prior authorizations in half.
What's more, automation can help reduce delays associated with prior authorization time to resolution. Practices who use SamaCare see an average turnaround time reduction of 84% by:
The goal of bringing transparent requirements to the prior authorization process is noble – but complex. Different payers require different documentation, have different policies around step therapy, different preferred formularies, even different processes for submitting a prior authorization. Even within the same payer, two different health plans may have completely different prior authorization policies for the same drug or procedure. SamaCare has observed firsthand the impact of these inconsistencies on patient access: we’ve seen denial rates for the same treatment range from 0-50%+ across different payers and plans.
While the goal of making these policies transparent is noble, healthcare providers will attest to the fact that inefficient processes and inconsistent policies make this very challenging – sometimes, the only way to optimize a prior authorization is through experience. These nuances require technology that not only automates the process, but also leverages AI to learn from disparate data sources on prior authorization approval and denial rates, denial reasons, etc. in order to proactively help practices navigate the prior authorization process. Transparency cannot exist without the technology to unify, interpret, and augment prior authorization data.
In our view, Dr. Oz was right about the changes that need to happen for prior authorizations:
You may love him. You may hate him. But when the person who’s set to lead the agency running the nation’s biggest healthcare programs talks about prior authorization, we definitely want to pay attention.
"When I sat with Senator Wyden last night, he asked about a similar issue, which is pre-authorization. We spend about 12% of the CMS budget on bureaucratic processes, the administration of the program, and most of that money is taken by middlemen, in ways that I don't think need to be true in the long term.
I believe we have the power right now, with technology that didn't exist even three or four years ago, to automate a lot of these processes, and pre-authorization's a good example. There are about 15,000 procedures that go through pre-authorization. Insurance companies, in aggregate, probably have 5,000 they'll list, but they only have to have about 1,000 in order to truly make a difference and make sure that the right procedures are done in the right way.
We should be able to create an experience for physicians and patients that we know almost immediately if what they are going through is requiring a pre-authorization, and if it does, what do they actually do to qualify for it. That could be instantaneous. By doing this rapidly, we'd cut out several percent of administrative cost, deal with the intense frustration the American people have, with pre-authorization, which was raised by many members of this committee, and we actually improve the care of people without costing or taking money out of the system. Those are the kinds of advances I believe we can champion."
SamaCare is a testament to the fact that automation can reduce time spent on prior authorizations. On average, medical practices using SamaCare to streamline and automate prior authorization submission, tracking, and renewals cut time spent by practice staff on prior authorizations in half.
What's more, automation can help reduce delays associated with prior authorization time to resolution. Practices who use SamaCare see an average turnaround time reduction of 84% by:
The goal of bringing transparent requirements to the prior authorization process is noble – but complex. Different payers require different documentation, have different policies around step therapy, different preferred formularies, even different processes for submitting a prior authorization. Even within the same payer, two different health plans may have completely different prior authorization policies for the same drug or procedure. SamaCare has observed firsthand the impact of these inconsistencies on patient access: we’ve seen denial rates for the same treatment range from 0-50%+ across different payers and plans.
While the goal of making these policies transparent is noble, healthcare providers will attest to the fact that inefficient processes and inconsistent policies make this very challenging – sometimes, the only way to optimize a prior authorization is through experience. These nuances require technology that not only automates the process, but also leverages AI to learn from disparate data sources on prior authorization approval and denial rates, denial reasons, etc. in order to proactively help practices navigate the prior authorization process. Transparency cannot exist without the technology to unify, interpret, and augment prior authorization data.
In our view, Dr. Oz was right about the changes that need to happen for prior authorizations:
