PA Checkpoint™

The Digital Front Door (DFD) methodology has emerged as a pivotal element in enhancing patient engagement, streamlining operations, and ensuring a competitive advantage. In a 2022 KLAS Top of Mind Research Report, 55% of healthcare leaders stated that their organization uses some form of DFD technology. The organizations that didn’t yet have one said it was on their radar for later implementation.

In today’s rapidly evolving healthcare landscape, optimizing revenue cycle management (RCM) in healthcare is paramount for providers aiming to maintain financial health while delivering exceptional patient care. However, traditional RCM solutions suffer from glaring inefficiencies that lead to frustrated patients and lost revenue. Enter the digital front door (DFD)—a holistic approach that enhances RCM by digitizing and centralizing various aspects of the patient journey. By streamlining everything from intake to bill pay, the DFD drives efficiency and addresses many of the shortcomings of traditional RCM along the way.

AVIA Marketplace's Top Revenue Cycle Management (RCM) Companies Report | Fall 2024

Digital RCM solutions are software platforms and technologies that automate and optimize the healthcare revenue cycle. These tools leverage advanced algorithms, artificial intelligence, and data analytics to streamline financial processes, improve efficiency, reduce errors, and provide actionable insights.

Prior authorization is a management process by which health care providers obtain approval from payers before delivering specific services in order to prevent lost revenue and reduce expenses.

The Top Digital Prior Authorization Companies Report is intended to provide healthcare leaders with a broad view of the prior authorization process and showcase standout companies and solutions with proven market traction. Users can view quick summaries to help them identify which solutions might meet their needs and visit AVIA Connect to access detailed profiles and verified client lists, compare solutions, and generate Match Scores to narrow their selections.

With its end-to-end automation platform VALER, Voluware offers a unified solution for prior authorizations, referrals management, and eligibility and coverage. VALER fully automates prior authorization submissions and includes a comprehensive form library and real-time payer information and status monitoring. The cloud-based solution covers all service types, including professional, facility, technical, pharmacy, and DME authorization workflows, and creates a centralized communication hub to capture faxed medical necessity documentation and phone exchanges with payers.

Prior authorization, or PA, remains a massive administrative burden for health plans and their provider partners, and often delays patient care. It also represents an untapped opportunity to improve patient care journeys and enable more successful value-based care arrangements. The Cohere Unify™ solution suite automates prior authorization intake and decisioning to drive administrative efficiency, while adding clinical intelligence to speed and improve patient outcomes.

At Arrive Health, the patient-provider relationship is our true north. Our solutions leverage accurate, patient-specific data to help providers reach the best decisions with their patients. With real-time notifications for coverage restrictions and prior authorization details, as well as automatic initiation of the electronic prior authorization (ePA) process, providers can significantly reduce administrative burden and ensure transparent communication with patients and care teams. Our directly connected network combines real-time prescription benefit data (from payers and PBMs) with automated ePA capabilities to reduce provider burden, improve patient engagement, and speed time to therapy.

Change Healthcare is focused on enabling a better, more efficient healthcare system through the power of the Change Healthcare platform. Our goal is to help payers, providers, and consumers improve clinical and financial outcomes so that everyone in the healthcare system can thrive. Despite all the automation innovations that exist today, authorization automation remains a complex challenge. Although the industry has recognized some success, many gaps still exist that require costly human intervention. The manual nature of prior authorization, the need for clinical documentation, and payer connectivity are some of the challenges Change Healthcare is solving today.

AVIA Marketplace's Top Prior Authorization Companies Why prior authorization matters What leading solutions offer AVIA Marketplace’s top prior authorization companies

Recently, I had the privilege of attending the AHA Rural Health Conference, a gathering that brings together healthcare professionals, administrators, and advocates from across the nation to address the unique challenges and opportunities within rural healthcare. The experience was not only enlightening but also deeply inspiring, highlighting the resilience, innovation, and dedication of those at the forefront of rural health. Reflecting on the conference, I’d like to share three key themes and takeaways that resonated with me, in the hope of offering some insights and encouragement to others navigating this vital field.

Conversational AI is an advanced technology that allows machines to understand, process, and respond to human language in a way that is both contextually relevant and interactive. Within the healthcare sector, this technology is increasingly deployed to automate routine tasks and deliver a more robust and personalized patient experience. Conversational AI leverages a combination of machine learning, natural language processing, and occasionally deep learning to interpret and respond to user inputs, with a conversational user interface that mimics human interaction. Digital health companies deploy conversational AI through chatbots, voice assistants, messaging apps, or any other type of platform where natural language interactions occur.

What is the digital front door? Digital front door describes a set of interactive and transaction-ready capabilities to enable digital interactions between patients and health systems throughout the care journey, from pre-service to follow-up and payment. When leveraged appropriately, a digital front door strategy can improve patient experiences, drive access, and reduce (or eliminate) reliance on paper-based workflows and manual processes.

AVIA Marketplace's 2024 Top Digital Front Door Companies, including: Why the digital front door matters What leading solutions offer AVIA Marketplace’s top digital front door companies

Patients demand convenient healthcare access akin to online services. A robust digital front door, integrating online scheduling, telehealth, patient portals, symptom checkers, and payment management, is crucial. It offers a competitive edge by enhancing accessibility, patient loyalty, brand perception, market reach, revenue, and leveraging data for insights, ensuring health systems meet modern expectations and stay competitive. Modern patients rightly demand that healthcare access be as straightforward as ordering a meal online or hailing a ride, which is still far from the norm.

According to a report from Accenture, patients are increasingly switching providers, and at least a portion say it’s because of the digital experience. In fact, the report goes on to show that digital engagement is a strong predictor of loyalty. Increasingly, patients say they are less likely to stay with a provider who doesn’t provide a good digital experience, and a bad digital experience effects how they feel about their entire healthcare interaction. In other words, great care or bedside manner doesn’t mean a patient will stay if the rest of their experience doesn’t meet their needs.

In today’s rapidly evolving healthcare landscape, health system CIOs, Innovation, Strategy, and Marketing executives are faced with a daunting task: selecting the optimal digital front door solution from a sea of options. This abundance of choices often leads to decision paralysis, costly DIY endeavors, or the adoption of solutions that fail to deliver value to consumers and yield no return on investment.

A consumer-grade digital patient experience solution must facilitate the holistic integration of all patient data, disparate technology solutions, and care services to deliver an experience that’s worth investing in — for both the patient and the health system at large. Otherwise, organizations risk introducing yet another fragmented solution into the market, one that fails to adequately address the diverse needs of patients.

As health systems seek out new ways to improve patient engagement, deliver a more consumer-centric experience, and expand capacity, having a clear digital front door strategy has become an increasingly essential component of their efforts.

The future of healthcare hinges on the powerful synergy between advanced technology and human expertise. The integration of AI is not just a trend but a pressing necessity. Patients are no longer willing to endure long wait times and often switch providers if their expectations for timely service are unmet. Additionally, the heavy workload and stress experienced by healthcare professionals in an overwhelmed system highlight the urgency of adopting AI solutions. AI’s transformative impact on the healthcare sector addresses the critical need for improved patient care and operational efficiency. By strategically integrating augmented intelligence at various touchpoints, health systems can streamline the care journey and offer a comprehensive digital front-door experience, resulting in increased patient satisfaction and higher-quality professional time.

In today’s digital age, a robust digital front door is not a luxury but a necessity for health systems aiming to meet patient expectations, improve operational efficiency, and stay competitive. By adopting a comprehensive DFD strategy, health systems not only enhance the patient experience but also achieve significant operational and financial benefits. As the healthcare industry continues to evolve, the digital front door will play an increasingly central role in shaping the future of patient care and fostering patient loyalty.

As a practicing physician, I, like many others, can easily become overwhelmed by administrative burden and information overload. Seeing many patients in a matter of minutes, means I have limited time to digest relevant information from the patient chart that could positively impact the way I deliver personalized care. Every day, clinicians search through numerous tabs in the EHR to gather data before seeing patients —reviewing new labs, notes, and telephone encounters. This leaves less time for patient encounters and even less time to research evidence-based care based on unique patient experiences. This discrepancy between best practice and care delivered, coupled with lots of wasted physician time, leads to suboptimal patient outcomes.

AVIA Marketplace's Top Clinical Decision Support (CDS) Companies Report | Fall 2024

What is clinical decision support (CDS)? Clinical decision support solutions encompass digital tools and systems that assist healthcare professionals in making clinical decisions for diagnosis, treatment, and management by providing them with evidence-based information, guidelines, and recommendations.