Big questions to be sure, but we tried to find answers during a recent Availity-sponsored SmartBrief webinar featuring healthcare industry expert Jay Eisenstock of JE Consulting.
You can watch the full webinar in the video above, but here are some highlights:
Automation has helped address some payer-provider pain points
The relationship between providers and health plans has long been considered challenging, with providers frustrated by unexplained denials and shrinking reimbursements, and health plans concerned that providers don’t do enough eliminate unnecessary procedures. These issues obviously still exist, but automating manual processes has mitigated some frustration by streamlining many administrative tasks and improving the speed and accuracy of provider payment.
There’s still a lot of work to do
Prior authorizations is one area where everyone agrees more needs to be done to improve payer-provider collaboration. It’s a time-consuming process that frustrates everyone: providers, health plans, and especially patients. Recently, a coalition of healthcare stakeholders, including AHA, AHIP, AMA, APhA, BlueCross Blue Shield Association, and MGMA jointly released a consensus statement committing to improve the prior authorization process.
Transition to value-based care is driving change
One of the biggest factors pushing health plans and providers to improve collaboration is the transition to value-based care. Improving patient outcomes and driving down the cost of care requires that plans and providers regularly exchange clinical data.
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