Analytics Relieves Payer Authorization Pains

THE CHALLENGE

Allina Health experienced payer authorization delays and denials for care its patients needed, creating anxiety and frustration for patients. Costs escalated as the organization had to add administrative resources to meet increasing payer demands. While anecdotal information was available, Allina Health needed data to compel payers to recognize and reconcile authorization issues impeding effective care delivery.

THE SOLUTION

Using the Health Catalyst^® data platform and a payer analytics application, Allina Health gained access to the data required to engage payers to address problems and improve processes. The organization can easily visualize the workload associated with each bill and quantify workload by payer, including trends over time. Allina Health can quickly demonstrate the direct impact of payer policy changes by service and claim and can drill into specific cases.

The organization provides payers actionable data and use cases where prior authorization processes aren’t working and collaborates to improve processes that benefit the patients, health system, and payer.

THE RESULT

Allina Health uses its high-quality data and analytics to foster trusting and collaborative working relationships with payers, enabling it to remove barriers impeding effective patient care delivery. The organization has decreased labor costs, increased profitability, and improved the patient experience.

• $279K payment increase for just one patient—demonstrating the substantial potential for increasing revenue.
• Three hours for radiation oncology treatment authorization, compared to one month for previous authorization, avoiding potential denial and reducing patient anxiety related to treatment delay.
• Resolving issues related to outstanding payments prevented the shifting of payment responsibility to patients.

"Approaching payers with actionable data changed the nature of the relationship. We‘re able to focus on data-informed improvement, decreasing the administrative burden and costs and improving the timeliness of care."
Lee Peterson, Director, Revenue Cycle Business Partners, Allina Health

ADDITIONAL READING

• Denials Management Analytics Reduces Denials by Nearly $5M
• Clinical and Financial Partnership Reduces Denials and Write-Offs by More than $3 Million
• Denial Managements Improvement Effort Produces $14.99M Reduction in Denials
• Integrated Data Platform and Improvement Efforts Recovers $3M in Revenue
• Don’t Negotiate Your Next Payer Contract Without These Three Phrases