Availity, the nation’s largest real-time health information network, is at HLTH 2024, one of the most anticipated trade shows in healthcare, to showcase its transformative multi-channel, API-powered intelligent authorization solution.
Empowering Providers and Payers Through Innovative Technology
In an increasingly complex healthcare environment, Availity brings decades of experience as a technology innovator, providing solutions that facilitate real-time digital healthcare interactions via its connected network of providers, payers, and partners. As a pioneer in multi-channel digital engagement, Availity’s API-powered approach simplifies and adds intelligence to critical healthcare interactions – taking aim at inefficient and burdensome administrative and clinical processes, such as prior authorizations.
“Availity’s platform empowers providers and payers to make faster, more informed decisions while reducing abrasion and lowering costs,” said Sean Barrett, Chief Product Officer, Availity. “We are excited to engage with HLTH attendees and demonstrate how Availity’s approach simplifies healthcare workflows, reduces operational burdens, and improves outcomes across the healthcare ecosystem.”
A platform approach to transforming utilization management
Availity’s intelligent, end-to-end authorization capabilities leverage FHIR and REST API connectivity, digitized workflows, AI-powered decisioning, and an expansive clinical data acquisition approach to help payers improve workflows and reduce the time and operational burden associated with prior authorizations, while minimizing provider abrasion through improved transparency and automation. By simplifying and speeding decision-making, Availity empowers payers to shift their focus from simply managing volumes and turnaround times, into a more strategic focus on care optimization – ensuring patients have timely access to the right care.
“Our strategic focus and investment in utilization in management solutions is being driven by multiple factors, including the 2027 deadline for the CMS Interoperability and Prior Authorization Final Rule,” said Barrett. “Availity’s platform approach to end-to-end authorizations not only ensures regulatory compliance for payers, but drives meaningful innovation and automation in these workflows on both sides of our dual-sided network – benefiting both payers and providers.”
The platform’s key components include:
- UM system integration: Availity integrates deeply into payers’ backend workflow systems, translating workflows into a digitally-enabled interface in which payers can easily configure authorization connections and routing. Microservices architecture and multi-channel integration capabilities offer maximum flexibility to optimize the end-to-end workflow and meet providers where they are.
- Submission: CMS-compliant APIs enable real-time submission of prior authorizations directly from EMR systems – in addition to Availity’s provider and submitter workflow channels. With a nationwide network of more than three million providers and extensive trading partner relationships, Availity serves as a single front door for capturing administrative and clinical data from across the healthcare ecosystem.
- Determination: The platform leverages responsible AI to automate, expedite and simplify prior authorization decision-making, ensuring compliance with evidence-based guidelines and timely access to appropriate care.
Availity Co-Presenting at HLTH
Availity will showcase these capabilities on stage at HLTH 2024, presenting its award-winning use case: “Using FHIR Standards to Streamline Prior Authorization Management & Improve Patient Care.”
The session will explore Availity’s collaboration to develop an automated prior authorization process leveraging the Da Vinci Burden Reduction Implementation Guides – a set of standards designed to make the process of prior authorization in healthcare more efficient and streamlined – to expedite approval of these requests and deliver a better, more seamless end-to-end experience for patients, providers, and payers.
Key outcomes of the collaboration include quicker patient access to care, improved provider efficiency, and decreased administrative burden versus previous manual processes. Stakeholders determined that during the evaluation period, nearly 54% of all requests required no authorization, and 70% of prior authorization requests processed through the implementation were instantly approved by the payer, due to the integration that enables robust data gathering and sharing. These instant approvals have contributed to a dramatic reduction in turnaround time from multiple days to about one day, which far exceeds industry averages that can range from days to weeks, and also outperforms the seven-day target established by the CMS Interoperability and Prior Authorization Final Rule.
Earlier this year, the collaboration was awarded the 2024 KLAS Points of Light Award for our solution, which celebrates success stories achieved by payers, healthcare organizations, and healthcare IT companies who have partnered to reduce costs and inefficiencies and improve the patient experience.
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