New England Baptist Hospital Shares Impressive Results of Prior Authorization Automation

The Massachusetts Health & Hospital Association invited prior authorization experts Dr. YiDing Yu, Verata Health CMO, and Jon Shaker, executive director of surgical business operations and patient access at New England Baptist Hospital (NEBH), to speak as part of its Hot Topics Webinar Series.

The webinar highlighted the sustained success of Verata Health’s prior authorization platform at NEBH, which has increased prior authorization throughput by 80% and reduced write-offs by 35% since implementing Verata’s AI-powered solution in 2017.

As health systems and hospitals affected by the COVID-19 pandemic scramble to cut costs and reduce inefficiencies to survive these challenging times, the nationally ranked Boston orthopedic hospital stands out as an organization that mitigated the effects of the pandemic by partnering with Verata.

Unblocking prior authorization bottlenecks

Several years ago, however, NEBH was suffering from seemingly insurmountable challenges that included frequent staff turnovers, long delays in patient scheduling, unacceptable phone abandonment rates, expensive write-offs, and little visibility into KPIs/metrics.

With prior authorization wait times averaging 11 days, patients expressed discontent and staff morale plummeted.

“At one point, things got so bad here that a number of our private physicians started to refer patients out of the Baptist network to our competitors,” Shaker said.

For years, NEBH had attempted to address these challenges by hiring more and more staff to support prior authorizations and the back-and-forth communications with provider offices and patients. Now they realized that something drastic had to change to reverse the prior authorization workload and deliver the type of streamlined care they promised their patients.

After studying the problem, Shaker said, “it was immediately evident to us that authorizations were primarily responsible for the inefficiency in the department as well as our staff’s frustration.”

That’s when the hospital turned to Verata Health to automate its process.

‘One of the best decisions’

NEBH implemented Verata Health’s powerful AI platform to seamlessly connect with their electronic medical record to:
●  Prepare prior authorizations automatically, eliminating administrative bottlenecks.
●  Retrieve CPT codes, LOS, scheduling, and clinical notes directly from the EMR, avoiding costly errors that lead to write-offs.
●  Automatically conduct status checks, cutting wait times and freeing up staff to focus on patient care.

“The implementation was one of the most efficient things I’ve been a part of here,” Shaker said about the switch to Verata’s platform. “Every target and milestone that Verata committed to was met. There were virtually no delays on their end, and we were able to expand to additional services much quicker than any of us could have imagined.”

Today NEBH uses Verata’s platform across all of their major service lines, including Advanced Imaging, Orthopedic Surgery, Spine Surgery, Pain, and PT/OT.

Almost immediately, NEBH began to see dramatic results:
●  Staff were freed up to answer phones and focus on patient care.
●  Telephone abandonment rates declined by 81%.
●  Turnaround time decreased 78% — from 11 to 2.5 days.
●  Write-offs dropped by 35%

“Ultimately, we determined this to be about a 4X ROI in the first year,” Shaker said. He quoted NEBH CFO Tom Gheringhelli, who referred to Verata as “one of the best decisions we’ve made.”

“This really has been a rare win-win-win — a win for the hospital, a win for our physicians, and, most importantly, a win for our patients,” Shaker said.

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Watch the entire webinar on the MHA website: Transforming Prior Authorization

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