What You Should Know:
– Blue Shield of California and Salesforce are joining forces to tackle a major pain point in healthcare: the lengthy and often frustrating process of prior authorizations.
– The new AI-powered platform solution, built on Salesforce Health Cloud, aims to deliver near real-time prior authorization decisions, streamlining healthcare delivery and improving patient experience.
Addressing the Burden of Prior Authorizations
Prior authorizations are a common practice in healthcare, ensuring that treatments and services are medically necessary and cost-effective. However, the current system is plagued by inefficiencies, often leading to delays in care and patient frustration.
The American Medical Association reports that 78% of physicians find prior authorization issues can cause patients to abandon treatment altogether. This is largely due to outdated processes, incomplete clinical information, and inefficient systems.
A Faster, More Transparent Future
This initiative goes beyond current efforts to improve prior authorizations, such as reducing the number of treatments requiring authorization or implementing “gold carding” for high-performing physicians. The Blue Shield and Salesforce partnership aims to transform this experience by:
- Streamlining Workflows: Consolidating 20+ disparate systems into a single, integrated process that leverages HL7 FHIR standards.
- Automating Requests: Enabling physicians to submit pre-populated electronic forms directly from their systems, eliminating the need for faxes.
- Delivering Real-Time Decisions: Providing prior authorization answers to members during their medical appointments.
- Enhancing Transparency: Offering patients real-time status updates through the Blue Shield member app.
- Facilitating Peer-to-Peer Consultations: Enabling quick and efficient communication between physicians for complex cases.
Integration with Blue Shield’s Care Connect System
The new platform will integrate with Blue Shield’s Care Connect system, allowing prior authorization requests to trigger automatic alerts to care teams. This enables proactive outreach to members who may benefit from additional support, such as diabetes reversal programs or other resources.
