Case Study
A Specialty Pharmacy Care & Growth Accelerator leveraged AI-powered solutions to improve the efficiency and speed of the prior authorization process.
Introduction
This client recognized the need to transform their operations to meet the evolving demands of their growing organization. They faced challenges in their prior authorization processes, including excessive manual work, reliance on multiple software applications, and the risk of human error leading to delays in patient care. To address these concerns, they embarked on a transformative journey leveraging AI-powered solutions to revolutionize their prior authorization processes. The primary objective was to significantly reduce the time spent on these manual, repetitive tasks thereby enabling them to scale the health system at minimal cost and allowing employees to focus on more meaningful tasks.
Before AI and Automation
- Repetitive, tedious data-entry work (I.e., constant back and forth between Epic, Epic Willow, and TRx)
- Over 25,000 hours annually spent on manual prior authorization tasks
- Reliance on multiple software applications hindered streamlining efforts and efficiency
- Human errors leading to 2x the work, delaying essential treatment for patients
- 300 FTES assigned to high volume of prior authorizations causing downstream issues with patient satisfaction, retention and revenue loss
Approach
In collaboration with Lydonia, this client implemented a 10-week engagement program. Lydonia evaluated the entire prior authorization process from start to end and identified nine “micro-processes” that were prime candidates for automation. With digital assistants, the solution targeted to automate 65% of the entire prior authorization process, integrating disparate software applications and mitigating human errors. The focus was on enhancing efficiencies and ensuring timely patient care.
Results
- Improved employee experience through the elimination of low-skill, time consuming tasks, allowing for more meaningful contributions
- Significant time and cost savings, with approximately 20,000 hours saved per year
- 362% ROI in 3 years
- Reallocated 41 FTES to revenue-generating activities, optimizing workforce utilization
- $3M in annual cost savings
- Ability to scale without adding headcount especially during periods of growth/high volume
- Elimination of human errors, enhancing patient care and satisfaction.