Why ePA and eBV are a start – but not quite enough Healthcare professionals generally gravitate to the field because they genuinely want to help people. In my experience, from senior clinicians to researchers to administrative staff, everyone’s goal is to ensure patients get the right treatment as quickly as possible. One thing not on their career plan? Spending hours on the phone trying to complete benefit verification (BV) and prior authorizations (PA). The healthcare system in the US is cumbersome. Even after the advent of electronic benefit verification (eBV) and electronic prior authorization (ePA) processes, BV and PA can remain frustrating and time consuming. The root cause: incomplete and/or lack of shared information among parties. Electronic solutions were created to help streamline complex processes, and in many cases they accomplish that goal. But unfortunately, often eBVs and ePAs can’t be completed without someone making a phone call to capture missing data anyway. In fact, according to a survey by AssistRX, healthcare providers reported access to patient coverage and PA indication/requirement are an area “needing the most improvement” – and that’s despite the specialty pharmacy industry being “ripe with eBV and ePA service providers.” The ‘false promise’ of portals Consider the following anecdote, shared with me by a customer. A healthcare administrator was charged with verifying whether an expensive outpatient procedure would be covered by a patient’s insurance. Using an electronic portal, they determined the surgery was approved. Unfortunately, the information exchange they were using had incomplete data, and the insurer later denied the claim – which, in effect, resulted in a $40,000 mistake for the surgery center. While it’s impossible to know exactly how often such problems occur, there’s a healthy distrust of the information electronic exchanges provide for reasons like this. The fact of the matter is healthcare providers need comprehensive answers to questions regarding patient coverage, and too often electronic solutions only offer limited information. This can happen for myriad reasons – information included in information exchanges is at the discretion of the payor. And, as the CCO of AssistRX points out, many eBV solutions only offer plan-level data, not patient-level data. For PA, the same can be true. If the information accessible via an ePA solution doesn’t have answers to all the questions a provider has (if it’s denied, why? How do I appeal? How do I submit the necessary materials? Who can I talk to for more information?), it’s not really saving time. And time cannot be underscored enough here – any delay to treatment for a patient can be serious. While PAs and BVs are provider responsibilities, they can have significant effects on provider and patient alike. As the AssistRX report details, ePA solutions “are sometimes disjointed, not as robust as purported, are based on algorithms rather than current data or have limited reach to payer-covered lives. Further, few solutions can deliver all of this information accurately, comprehensively and in a digestible format.” What this tells us is that electronic solutions were designed to help make healthcare providers’ jobs easier, and they are certainly a start. But providers are often telling a different story: They can still add work to their plates and, unfortunately, delays to patient care. Helping stakeholders across the healthcare landscape It’s no secret the healthcare industry has been slow to embrace technology when compared to other industries. But that’s not because assistance isn’t needed. I’ve seen firsthand the need for an advanced solution that helps everyone in the care flow do their best work – and that’s what we’re working on at Infinitus. In fact, by taking over much of the administrative work of sourcing information from electronic sources or making BV and PA calls, Infinitus benefits everyone involved in decision making. Patients can access prescribed therapies earlier. Clinicians have more time to practice at the top of their license. Healthcare tech leaders like the efficiency of our solution, which can be integrated into EHR solutions with no upgrading or reprogramming necessary. Payor reps are more efficient when talking with our digital assistant, and have higher-quality, shorter calls. Pharmaceutical manufacturers and pharmacists can see a reduction in prescription and code errors, as well as call abandonment. Healthcare workers have been through a lot over the last few years. At Infinitus, we are working to make the patient, provider, and payor experiences more satisfying, and, frankly, less soul-crushing. This is where the Infinitus digital assistant really shines. It helps the provider execute administrative tasks as quickly as possible without causing more distress, so that each has more time to help patients and members – the likely reason they entered the profession in the first place. A recent analysis of one of our customers found that our digital assistant saves 15 to 30 minutes on each call. Imagine what your team could do with that time? You can see the Infinitus digital assistant in action in this demo call, or contact us for more information.