Health Worker Burnout: Transform Prior Authorization Process

Last week, Surgeon General Vivek H. Murthy, M.D., M.B.A. released a new Surgeon General’s Advisory report highlighting the country’s health care worker burnout crisis. Health care workers, including physicians, nurses, nurses aides, and community and public health workers, among others, have long faced systemic challenges in the health care system even before the COVID-19 pandemic, leading to crisis levels of burnout in the workforce.

The National Academies of Medicine reported that burnout had reached “crisis” levels, back in 2019, with up to 54% of nurses and physicians, and up to 60% of medical students and residents, suffering from burnout. Throughout the pandemic, we’ve heard, first-hand, from physicians that responding to this public health crisis has further exacerbated burnout for them and their staff.

The new Surgeon General’s Advisory Addressing Health Worker Burnout outlines six key recommendations for health care organizations, health insurers, health technology companies, policymakers, academic institutions, researchers, and communities to address health worker burnout and ensure their well-being:

• Transform workplace culture to empower health workers and be responsive to their voices and needs;
• Eliminate punitive policies for seeking mental health and substance use disorder care;
• Protect the health, safety, and well-being of all health workers; 
• Reduce administrative burdens to help health workers have productive time with patients, communities, and colleagues; 
• Prioritize social connection and community as a core value of the healthcare system; and  
• Invest in public health and our public health workforce.

As a recognized leader in intelligent utilization management technology, Cohere Health submitted a letter to Surgeon General Murthy outlining recommendations on industry best practices for reducing the administrative burden posed by prior authorization (PA) requests and urging health insurance companies, organizations, and payers to take further steps toward addressing this issue.

Converting prior authorization systems from the traditional fax-based approach to one that leverages the immense gains in technology over the last several years will revolutionize provider workflows, improve patient care, and reduce the unnecessary administrative burden that’s contributing to health worker burnout and resignation.

Cohere’s platform eases the administrative burden on health workers by utilizing machine learning, interoperability, and advanced analytics to streamline the prior authorization process and accelerate patient access to high-value care. We accomplish this through:

• Automated clinical intelligence that guides high-value care choices;
• Intelligent authorization platforms that are clear on their clinical criteria hierarchy;
• Machine learning (ML) & Artificial Intelligence (AI)-driven authorization features that ensure the proper completion of all prior authorization requests; and
• Smart prior authorization technologies that can determine longitudinal patient journeys for a wide range of conditions that allow for a bundled authorization of services, rather than having providers submit several disconnected requests for one patient. 

In order to transform how the health care system handles prior authorization, we believe all parties – health plans, physicians, and patients – need to understand how much they have to gain, both in terms of lower costs and better health, by pursuing a different approach.

Cohere’s platform makes the value of a fundamental change clear by aligning physicians and health plans on evidence-based treatment plans for the patient’s entire episode of care, driving improved care quality and reduced cost, resulting in:

• 40% reduction in provider administrative burden; 
• 70% faster patient access to care;
• 63% lower denial rate; and
• 92% provider satisfaction rate.

Interested in learning more? Contact Cohere Health today!