Providers

Robotic Process Automation (RPA) Improves Oncology Patient Care

Alti Rahman, MHA, MBA, CSSBB and Syam Palakurthy

Alti Rahman, MHA, MBA, CSSBB and Syam Palakurthy

Practice Administrator, Oncology Consultants

Background

The prior authorization process is broken and it’s not getting better; so say 88% of physicians who agree the prior authorization burden has increased over the past 5 years, according to a survey by the AMA. At Oncology Consultants, a community-based Oncology practice with 12 locations in the Greater Houston Area, the onerousness of the prior authorization process for physician-administered oncology treatments was becoming increasingly evident, so they set out to understand the impact of process inefficiencies on practice management and patient care. 


Opportunity Cost of Cumbersome Prior Authorizations

Oncology Consultants regularly deals with at least 12 major payer networks. The prior authorization process for each payer differs, requiring data to be moved manually from internal systems like EMRs and practice management software to individual payer portals—  when payers have digital portals at all. Oncology Consultants found their associates were spending significant time moving data between systems, a manual task that creates higher risk for human error. Additionally, after submission, their associates had no way of knowing the status of a prior authorization approval, requiring them to manually check on each individual prior authorization multiple times, which often involved lengthy phone calls to payers. Based on the time spent per prior authorization, their practice would soon need to invest in more resources to manage prior authorizations — dollars that would effectively be diverted away from value-added services for patients, like increasing the size of their patient care team to enable greater patient engagement between office visits. 


Prior Authorization Process Affects Patient Care

Oncology Consultants noted that even if the majority of their prior authorizations ultimately were approved, the onerous process of obtaining prior authorization approval had a deleterious effect on patient care. In addition to the opportunity cost of devoting more resources to an essential but not value additive component of patient care, preventable prior authorization process inefficiencies could lead to delays in patient treatment. When a patient has just received a cancer diagnosis, it creates unnecessary anxiety and stress to learn they must wait for approval to receive treatment. Moreover, studies have shown those delays can also lead to worse outcomes: one recent study by researchers at the Cleveland Clinic found each week of delay in starting cancer therapy could be linked with a 1.2% to 3.2% increased risk of death. 


Oncology Consultants also noted that delays in receiving prior authorization feedback resulted in financial anxiety for patients waiting to understand out-of-pocket (OOP) costs associated with treatment. Additionally, time spent tracking down problematic prior authorizations took away from time practice administrators could spend helping patients find financial assistance for OOP costs. 

Using RPA to Improve PA 

Oncology Consultants analyzed the time it took to complete each step in the prior authorization process. They found that on average, across payers, their staff spent 20.6 minutes per prior authorization, accounting for both the percentage of prior authorizations that were straight-forward and the percentage of prior authorizations that spiraled into multiple days spent tracking down prior authorization status, troubleshooting errors, etc. Moreover, the manual PA process created avoidable errors like the wrong or missing ICD-10 code, incorrect forms, prior authorization forms submitted to the wrong location, etc. 


Experiment 

Oncology Consultants worked with Samacare, a free platform that helps providers streamline the prior authorization process, in part by leveraging robotic process automation (RPA). Robotic process automation refers to the application of technology (bots) to automate business processes that involve humans interacting with digital systems. The idea is to eliminate manual tasks that do not require higher level thinking, while simultaneously creating a scalable digital process to better submit, track, and manage prior authorizations. 


Results

By leveraging robotic process automation, Oncology Consultants was able to reduce time spent per prior authorization by 43%. Robotic process automation helped reduce time spent on prior authorization submissions by automating the transfer of data between systems, while also eliminating the need for manual status checks on submitted prior authorizations. Oncology Consultants also saw a reduction in prior authorization delays or denials caused by human error, though that reduction was not quantified as part of this study.

Conclusion

Reducing time spent on prior authorizations enables practices to reallocate resources to value additive patient care, reduce delays caused by preventable human errors, and ultimately improve patient care. 


In addition, the “digital breadcrumbs” created by a more automated approach to prior authorization can enable practices, like Oncology Consultants, to gain a more holistic understanding of all prior authorizations. For example, RPA makes it possible to answer questions like “what is the average approval rate for this drug with a specific payer,” or “what is the average time to approval for this drug with a specific payer”. These insights arm providers with data to work directly with payers to proactively improve the process and ultimately the patient experience. 


While this exploration applied robotic process automation to submit and track prior authorizations, these are just the first steps in utilizing technology to improve the prior authorization process. For example, RPA could be used to assist in proactively checking if a medication requires prior authorization, understanding payer biosimilar preferences, and more. Similarly, the insights generated by a unified prior authorization process can help practices be more proactive in avoiding common hurdles in the prior authorization process that lead to delays in patient care. While the prior authorization process will never be perfect, technology like RPA can arm practices with the tools they need to provide patients with the best possible care within our existing healthcare system. 


Providers

Robotic Process Automation (RPA) Improves Oncology Patient Care

Alti Rahman, MHA, MBA, CSSBB and Syam Palakurthy

Alti Rahman, MHA, MBA, CSSBB and Syam Palakurthy

Practice Administrator, Oncology Consultants

Background

The prior authorization process is broken and it’s not getting better; so say 88% of physicians who agree the prior authorization burden has increased over the past 5 years, according to a survey by the AMA. At Oncology Consultants, a community-based Oncology practice with 12 locations in the Greater Houston Area, the onerousness of the prior authorization process for physician-administered oncology treatments was becoming increasingly evident, so they set out to understand the impact of process inefficiencies on practice management and patient care. 


Opportunity Cost of Cumbersome Prior Authorizations

Oncology Consultants regularly deals with at least 12 major payer networks. The prior authorization process for each payer differs, requiring data to be moved manually from internal systems like EMRs and practice management software to individual payer portals—  when payers have digital portals at all. Oncology Consultants found their associates were spending significant time moving data between systems, a manual task that creates higher risk for human error. Additionally, after submission, their associates had no way of knowing the status of a prior authorization approval, requiring them to manually check on each individual prior authorization multiple times, which often involved lengthy phone calls to payers. Based on the time spent per prior authorization, their practice would soon need to invest in more resources to manage prior authorizations — dollars that would effectively be diverted away from value-added services for patients, like increasing the size of their patient care team to enable greater patient engagement between office visits. 


Prior Authorization Process Affects Patient Care

Oncology Consultants noted that even if the majority of their prior authorizations ultimately were approved, the onerous process of obtaining prior authorization approval had a deleterious effect on patient care. In addition to the opportunity cost of devoting more resources to an essential but not value additive component of patient care, preventable prior authorization process inefficiencies could lead to delays in patient treatment. When a patient has just received a cancer diagnosis, it creates unnecessary anxiety and stress to learn they must wait for approval to receive treatment. Moreover, studies have shown those delays can also lead to worse outcomes: one recent study by researchers at the Cleveland Clinic found each week of delay in starting cancer therapy could be linked with a 1.2% to 3.2% increased risk of death. 


Oncology Consultants also noted that delays in receiving prior authorization feedback resulted in financial anxiety for patients waiting to understand out-of-pocket (OOP) costs associated with treatment. Additionally, time spent tracking down problematic prior authorizations took away from time practice administrators could spend helping patients find financial assistance for OOP costs. 

Using RPA to Improve PA 

Oncology Consultants analyzed the time it took to complete each step in the prior authorization process. They found that on average, across payers, their staff spent 20.6 minutes per prior authorization, accounting for both the percentage of prior authorizations that were straight-forward and the percentage of prior authorizations that spiraled into multiple days spent tracking down prior authorization status, troubleshooting errors, etc. Moreover, the manual PA process created avoidable errors like the wrong or missing ICD-10 code, incorrect forms, prior authorization forms submitted to the wrong location, etc. 


Experiment 

Oncology Consultants worked with Samacare, a free platform that helps providers streamline the prior authorization process, in part by leveraging robotic process automation (RPA). Robotic process automation refers to the application of technology (bots) to automate business processes that involve humans interacting with digital systems. The idea is to eliminate manual tasks that do not require higher level thinking, while simultaneously creating a scalable digital process to better submit, track, and manage prior authorizations. 


Results

By leveraging robotic process automation, Oncology Consultants was able to reduce time spent per prior authorization by 43%. Robotic process automation helped reduce time spent on prior authorization submissions by automating the transfer of data between systems, while also eliminating the need for manual status checks on submitted prior authorizations. Oncology Consultants also saw a reduction in prior authorization delays or denials caused by human error, though that reduction was not quantified as part of this study.

Conclusion

Reducing time spent on prior authorizations enables practices to reallocate resources to value additive patient care, reduce delays caused by preventable human errors, and ultimately improve patient care. 


In addition, the “digital breadcrumbs” created by a more automated approach to prior authorization can enable practices, like Oncology Consultants, to gain a more holistic understanding of all prior authorizations. For example, RPA makes it possible to answer questions like “what is the average approval rate for this drug with a specific payer,” or “what is the average time to approval for this drug with a specific payer”. These insights arm providers with data to work directly with payers to proactively improve the process and ultimately the patient experience. 


While this exploration applied robotic process automation to submit and track prior authorizations, these are just the first steps in utilizing technology to improve the prior authorization process. For example, RPA could be used to assist in proactively checking if a medication requires prior authorization, understanding payer biosimilar preferences, and more. Similarly, the insights generated by a unified prior authorization process can help practices be more proactive in avoiding common hurdles in the prior authorization process that lead to delays in patient care. While the prior authorization process will never be perfect, technology like RPA can arm practices with the tools they need to provide patients with the best possible care within our existing healthcare system.