Google Cloud is tackling the cumbersome problem in healthcare of slow preauthorization of recommended procedures, medications, or devices. On April 13, the company introduced its AI-enabled Claims Acceleration Suite to reduce these administrative burdens and costs for health plans and providers. The prior authorization process causes burnout for physicians, notes Amy Waldron, director of Global Health Plans Strategy and Solutions for Google Cloud. In fact, 88% of physicians call it "very or extremely" burdensome, according to the Medical Group Management Association. The Centers for Medicare & Medicaid says prior authorizations take an average of 10 days.

Physicians spend nearly two full business days per week on prior authorization requests as part of an antiquated, manual process. Prior authorization is the "single highest cost for the healthcare industry" in the U.S., totaling some $767 million a year, according to the CAQH index. Physicians spend nearly two full business days per week on prior authorization requests, and payers devote thousands of manhours reviewing and approving them in an antiquated, manual process involving phone calls and faxes. The arduous task often delays necessary treatment and sometimes results in treatment abandonment -- patients just get tired of waiting, so they give up -- both of which hurt patient outcomes and ultimately raise costs in the long run. Prior authorization has been identified as one of the biggest opportunities for applying artificial intelligence (AI) to help lower the administrative burden and cost.

BOSTON, June 30, 2021- Cohere Health, an emerging high growth digital health company, today announced it has earned Utilization Management Accreditation from the National Committee for Quality Assurance (NCQA), validating that the company's digital prior authorization platform conforms to the industry's highest standards. It is the first such known digital prior authorization solution to receive NCQA accreditation. Health plans have traditionally used utilization management to ensure that patients are receiving proper care, reduce unnecessary overuse of resources, and minimize variation from evidence-based care. However, as health plans look to meet interoperability, analytics and timeliness requirements legislated at the state and federal levels, electronic prior authorization vendors have not kept up with quality standards. The most prominent health plans in the country are NCQA certified, and an NCQA Utilization Management Accreditation helps guarantee that organizations making these decisions are doing so based on objective, evidence-based best practices.

Front- end Bot Patient Databases No Update Create authorization request Bot pre-fills authorization request, reviewer completes it and submits Check status Update status Yes No Yes 1 34 5 6 7 8 9 10 26.

In the fight between health insurers and patients, I have seen that healthcare providers are caught squarely in the middle, which can be a costly position. The provider's battle begins before the patient enters the medical facility. Studies show that providers can spend as many as 20 hours a week getting preauthorization for their patients. It is a lengthy process that can cost each provider an average of $83,000 annually, and that figure can increase when you factor in lost productivity. The battle often continues long after the patient has been seen.