HIMSS’19 Recap: Prior Authorization Solutions Remain Top of Mind

By Infinx
February 25, 2019
06:01 am

The Healthcare Information and Management Systems Society (HIMSS) recently held its 2019 global conference in Orlando, Florida, addressing top-of-mind topics in healthcare information technology. More than 45,000 healthcare and information technology professionals and 1,300 vendors attended the week-long event, including the Infinx team.

Here is a quick rundown of the technology topics and emerging trends that sparked our interest — prior authorization, artificial intelligence (AI), data and analytics, and blockchain technology.

Raising Awareness for Prior Authorization Automation

Prior authorization continues to be an issue for most clinicians and patients. Tyler Scheid of the American Medical Association cited his organization’s 2018 prior authorization survey, which found that 65 percent of 1,000 physicians waited at least one business day for a prior authorization decision, and 26 percent reported waiting for three business days.

What’s more, nearly all of reporting physicians said prior authorization issues led to delays in care, and 75 percent said it resulted in the abandonment of treatment. Perhaps most concerning is the fact that 88 percent of physicians reported that their PA burdens had grown over the last five years.

Heather McComas, AMA director of administrative simplification issues, discussed the industry’s recent consensus agreement, outlining the principles that addressed clinical validity, continuity of care, transparency and fairness, timely access and administrative efficiency, and alternatives and exemptions.

McComas said the AMA fully supports electronic prior authorization and increased automation. McComas bemoaned the fact that the prior authorization process across the industry is still “largely manual” and “costly for everyone involved.”

Some of the problem might be education, according to McComas. Only half of the physicians surveyed were aware of prior authorization technology.

“Everything depends on creating physician awareness of electronic prior authorization and its advantages,” said Tyler Scheid of the AMA. “Vendors also must assure that all information related to physicians at the point of care is accurate and up to date.”

Artificial Intelligence is Key to U.S. EHR Revolution

Gartner estimates that by 2025, 65 percent of all automated healthcare delivery processes will involve some form of AI. Consequently, it’s not surprising AI was top of mind at HIMSS’19, specifically as it related to machine learning, natural language processing (NLP), and robotics — all of which can be leveraged to automate repetitive manual tasks and improve decision-making.

Leaders in the healthcare industry as well as technology vendors like Infinx are witnessing this first hand and are working to integrate AI with next-generation analytics platforms.

The convergence of artificial intelligence, machine learning and NLP suggest a holistic, real-time view of the patient may be right around the corner. Yet the tech still needs to evolve some. Diverse language and syntactic subtleties in the U.S. remain challenges to current AI algorithms. Yet developing NLP platforms are closer than ever to handling the wide assortment of American dialects and even mood, emotion and sentiment.

In the near future, every American will be able access their entire health record on their smartphone and combine it with fitness and wellness apps to optimize health. Some of the challenges remaining center around documentation, prior authorization and price transparency. Issues to consider moving forward include maintaining privacy and security without information blocking and free information access for the patients.

As AI applications become more available and affordable, the expected return on investment with incentivize a broad array of healthcare industry participants to utilize it as an analytic engine.
High quality, labeled datasets from local populations are crucial to accurately training AI algorithms. Better data is more important than bigger data.

Putting Big Data to Work for the Consumer

Managing massive amounts of data was another huge topic at HIMSS’19. The big piece is how providers, payers and others make the data work for the consumer and how they keep pace with new innovations.

Individual physicians cannot keep up and are starting to use clinical decision support. The physician is getting more power with AI in the background, to make a decision on the best action going forward.

The modern data center will have a major influence on medical care as it is key to delivering high-quality care while keeping costs in check. Digital health, value-based medicine, healthcare consumerism, big data analytics and AI are among the trends that healthcare leaders are grappling with. Having a data center capable of dealing with the growing abundance of data, compute-intensive algorithms and advanced analytics is key.

Virtualization enables providers to securely access their patients’ data anywhere and on any device. Of course, with the development of these technologies, it’s increasingly important that private companies and government work together to achieve interoperability in healthcare technology. Key to this mission is putting actionable patient health information into consumers’ hands by building a portal for a consumer-facing application into every EHR. Consumers could then pull whatever medical data they needed to make reasoned healthcare decisions and to hold providers accountable. To achieve this, EHR vendors must agree on uniform standards for interfacing with and retrieving information from any EHR.

Blockchain Will Enable Truly Secure EHR Data

Blockchain technology could transform healthcare, placing the patient at the center of the healthcare ecosystem and increasing the security, privacy, and interoperability of health data. Potential applications include patient-centric health records, provider licensure and credentialing, supply chain management in conjunction with predictive analytics and more accurate tracking capabilities.

Current record-keeping systems are siloed in many different places, which means that records can be incomplete, conflicting or ambiguous. Blockchain-stored records can provide complete health records for individuals, and give patients more control over their own information.
Blockchain can enable the creation of secure validated health record data, anonymous linking of identities with other transactional data, and recordation of patient consent — all without a central gatekeeper. Blockchain is also well-suited for provider credentialing and health plan provider directories.

Infinx at HIMSS’19

Infinx Healthcare’s VP of Products, Navaneeth Nair, led a well-received session in which he explained how the rapid development and improvements in AI algorithms and their ability to impact healthcare will have significant implications to revenue and payment processes.

The Infinx team also spent much of HIMSS’19 answering questions about our prior authorization solution, which is a hybrid of platforms that leverages automated workflows, robotic process automation, and AI with exception handling by certified prior authorization and billing specialists.

We don’t want you to just take our word for it though. Schedule a demo today and learn how our prior authorization software solution can simplify your workflow and increase cash flow.

About the Author

Infinx

Infinx

Infinx provides innovative and scalable payment lifecycle solutions for healthcare practices. Combining an intelligent, cloud-based platform driven by AI with our trained and certified coding and billing specialists, we help clients realize revenue, enabling them to shift focus from administrative details to billable patient care.

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