Despite today’s technological advancements, a large amount of prior authorization requests are submitted via fax machine. A new partnership between Blue Shield of California and Salesforce will address this issue.
The partnership was announced Monday at HLTH 2024 in Las Vegas. The two companies will build a new solution on Salesforce Health Cloud that will allow physicians and patients to receive prior authorization answers in almost real-time. Testing for the solution begins in early 2025 with a limited rollout to start.
Upon the physician’s request, the solution will search the patient’s electronic health record for relevant clinical information and organize it into a pre-populated electronic form. Physicians will then be able to submit prior authorization requests right away through their systems, and patients will receive an answer during medical appointments.
If a case needs clinical consultation, the physician will receive a message explaining what’s required to finish the prior authorization request. Typically, this process can take days, but the new solution aims to reduce it to hours. Through the Blue Shield member app, patients will also receive updates on their prior authorization requests. Any denial of a request will be made by a medical director or licensed clinician, according to the announcement.
Prior authorization is a controversial topic for providers and payers, with a lot of finger-pointing between the two parties. Providers argue that it causes an administrative burden and delays patient care. According to the American Medical Association, 78% of physicians report that prior authorization issues lead to patients foregoing care. Payers, meanwhile, argue the process is needed to avoid unnecessary care and reduce costs. The partnership between Salesforce and Blue Shield of California aims to make this issue less tense.
“There’s no finger-pointing if there’s no problem,” said Jeff Amann, executive vice president and general manager of Salesforce Industries, in an interview. “That’s the objective. Of course, there will be exceptions, but those exceptions are learning opportunities for the business system.”
Paul Markovich, CEO of Blue Shield of California, said that the companies hope to make prior authorization as easy as using a credit card with its new solution.
“To me, the biggest thing we can do — and this is where the health plans I think are most at fault — is create a system where it can be like using a credit card,” Markovich said in an interview. “Sometimes your credit card will be like, ‘Whoops, wait, call this number.’ That’s going to happen in this process, too, and you can immediately get somebody on the phone. You can talk to a clinician, you can schedule at a convenient time, there’s always going to be a human in the loop for any kind of time that we can’t fully approve prior authorization.”
While Blue Shield of California co-developed this solution, the companies hope other insurance companies will use it in the future, Markovich and Amann added.
Photo: Piotrekswat, Getty Images
