Revolutionizing prior authorization solutions

0:03 Good morning and welcome to the Health Leaders Revenue Cycle Now Online Summit. 0:07 My name is Luke Gale. 0:08 I am the Revenue Cycle Editor for Health Leaders and will serve as your moderator for this session. 0:13 The final session of our event today is titled Revolutionizing Revenue, Technology and Strategic Solutions for Prior Authorization, sponsored by Optum. 0:22 Thank you to our sponsor for making today's program possible, and you in our audience, for participating today. 0:28 Before we get started, I have a few housekeeping details. 0:32 Our program will be 60 minutes in length. 0:35 An on-demand version of this program will be available approximately 1 day after the completion of the event. 0:40 Can be accessed using the same login link that you used for the live program. 0:44 To ensure that you can see all the content for the event, please maximize your event window and be sure to adjust your computer volume settings and/or PC speakers for optimal sound quality. 0:54 Next, you will find a resources list for today's webinar in the upper right of your screen. 0:59 Here, we have listed supplemental resources in the Event Program Guide for you to download the price, topic, and panelist information from each session. 1:07 At the bottom of your console are multiple widgets you can use, to submit a question 1:12 click on the Q&A widget. 1:14 It may be open already and appear on the left side of your screen. 1:18 You may submit questions at any time during the presentation. However, please note that it is likely that your questions will not be answered into the Q&A portion of the program. 1:27 Finally, should you experience any technical difficulties during today's program and need assistance, please click on the Help widget for the question mark icon and covers common technical issues. 1:39 At this time, it is my pleasure to introduce our panelists, Savanah Arceneaux, Director, Free Service and Financial Clearance at Ochsner Health, Christine Migliaro, Vice President of Front End Revenue Cycle Operations at Northwell Health and Samantha Wyld, Partner and Senior Director at Optum Advisory. 1:59 Thank you all for joining me today. 2:01 And with that, let's get into our discussion. 2:05 First, please tell us a little bit about yourselves and your organizations. 2:09 Christine, can you start? 2:11 Yeah, sure. 2:11 Thanks for having us today, Luke. 2:13 So my name is Christine Migliaro. 2:14 I'm the Vice President for Revenue Cycle Operations here at Northwell Health. 2:17 We are the largest employer here in New York State. 2:20 And as of May 1st, we're going to do an expansion with Nuvance joining us. 2:24 So we will become a 28 hospital system with about 103,000 employees and 2:33 1,050 ambulatory locations. And with Nuvance joining us, it'll take us to a 22 1/2 billion dollar operation. 2:41 And Savanah, hi, I'm Savanah Arceneaux with Ochsner Health. 2:47 Ochsner is a nonprofit healthcare provider across the Gulf South. We serve 46 hospitals across her system and have about 5,000 physicians. 2:58 And I always like to say that we are an Epic Shop and a single billing office. 3:05 And Samantha. 3:08 Good morning, I'm Samantha Wyld 3:09 I'm a partner and Senior Director with Optum Advisory, which is the consulting division of Optum. 3:15 We are a leading provider of professional services across the comprehensive provider enterprise, meaning we work with organizations in the ambulatory or physician space and the acute care inpatient space, as well as some work in the post-acute care space. 3:28 I've been part of our group since 2008 and have worked across the entirety of the revenue cycle spanning front, mid, and back end. 3:36 Though my passion projects and areas of greatest interest have always been in the front end or patient access. 3:43 And I've spent a lot of my career really focusing on the intersection of the revenue cycle from an administrative function with consumerism and the patient experience. 3:52 So a pleasure to be with you all today. 3:56 Thank you all for joining me today. 3:57 And with that, let's get into our discussion. 4:01 First question, what are your biggest challenges in managing prior authorizations? 4:05 Savanah, can you start? 4:08 Yes, thanks Luke for this question. 4:10 Honestly, where do I begin? 4:12 I think, you know, we all understand if if you've had anything to do with the prior auth process that it is a very time-consuming process. 4:20 That's just the nature of it. 4:22 Obviously you know, there's a lot of complexities within the payer roles and guidelines that are everchanging and really just the lack of standardization across the systems, across the payers ways that we can get the information to know if prior auth is required, ways that we submit it. 4:41 And then I think, you know the big-ticket item that we've all been really focused on lately is the increase in denials or prior auth denials. 4:51 Samantha, do you have anything to add to that? 4:55 Absolutely. 4:55 I have the opportunity to work with usually at any given time about a half dozen provider organizations. 5:01 And I think the consistent threads that I'm hearing are what you heard in terms of just volume of prior authorizations has certainly gone up. 5:09 There are huge variances market by market and some of that is driven by how much you've seen your organization increase in Medicare Advantage enrollees compared to traditional Medicare where we didn't have the burden of prior authorizations, particularly in the provider ambulatory setting. 5:26 So the volume I think has gone up. 5:28 And then I think that prior authorizations is one of those sort of Evergreen-challenging areas because the rules of the road consistently change. 5:36 Providers are always having to keep up with what new procedure or what new service is now requiring a prior authorization. 5:44 And every payer has their own set of rules. 5:47 All commercial payers have their own rules. 5:48 And then of course, CMS has their rules and guidance as well. 5:52 And so I think it's just a moving target that requires consistent effort, refinement and focus as well. 6:00 Thank you, Samantha. 6:01 Christine, can you tell us about the challenges you experience at Northwell? 6:05 Yeah, sure. 6:06 So where I completely agree with everything that Sam and Savanah have brought up, things that also were really confusing is that every payer has different ways that they want you to communicate with them. 6:16 Some are faxing, some are making phone calls, some you have to go on websites and submit documentation and then follow up. 6:22 So that's also very confusing. 6:24 And how does you know how people do that. Delays in care 6:28 You know, sometimes you have to submit these authorizations, you know, 10 days in advance, you know, two weeks in advance. 6:33 And a lot of times our surgeons, you know, want to move forward or want to, you know, have care. 6:38 During COVID, we had a lot of shortages. 6:41 So we had people that didn't want to work inside the offices. 6:44 So then we had to start looking for outsource vendors or people that were willing to take on the space and people that you could collaborate with and then create new workflows on how do you pull them into, you know, your process. 6:55 And then I think, you know, looking at it from sometimes from the patient's point of view, you know, we always look at it from our point of view, but that patient, you know, delayed access to care, sometimes a financial hardship, you know, the doctors telling them they need a procedure and they need something done, but the their insurance company is not paying for it. 7:11 So now you have to start having conversations with them about the cost that it's going to be for them. 7:15 And then the frustration and confusion that happens on both sides, you know, so what's approved? 7:20 What isn't approved? 7:21 You know, how do we let the patients know? 7:23 And then authorizations are really getting a lot into the into the pharmacy space now too, with all these high-end, you know, medications and weight loss medications and things like that and even in just some diabetic medications. 7:35 So then you start to have patients that are lacto adherence on some of their medications because they can't afford it or their insurance companies aren't approving it. 7:41 So then they just choose not to take the medication. 7:46 Great. 7:49 Technology is obviously a hot topic. 7:51 Samantha, can you tell us how technology is helping or hindering prior authorization processes? 7:58 Sure. 7:59 Well, I think to Christine's point, there's many different sort of modes or channels that different payers want you to use. 8:05 So I think in some instances we've seen, you know, I often joke if anyone else is a fellow father of the bride movie enthusiast, I'll often say welcome to the 90s, Mr. 8:14 Banks, because health care is one of the few industries that still leverages faxes. 8:19 I mean it's fairly archaic, but a fair bit of prior authorization work is still done via fax machine. 8:25 I think one of the advents of the payer portals to be able to use a web link and communicate with payers electronically in lieu of faxes is certainly a step in the right direction. 8:37 But I think one of the challenges is I work with many clients and they have the myriad of different staffing models. 8:44 They have some resources which we consider a best practice that are really centralized and dedicated to working prior authorizations and prior authorizations alone. 8:52 So a dedicated authorization group or team. 8:56 But we have other organizations where they have Jacks and Jills of all trades and they have staff who are scheduling patients, getting prior authorizations, you know, answering calls, completing checkout and then doing prior authorization as one of many functions. 9:10 And in either situation, those staff who are really the front lines of obtaining the prior authorizations sometimes have to have unique logins to two dozen or more payer portals depending on which pairs are actually using online versus who is still requiring faxes or calls to the payer. 9:28 And so I think advancements in moving away from fax have been great. 9:33 We have seen as well, automation is coming into play in the prior authorization space in various different ways that we've seen that and some that have been really successful, others that have had some more public, you know fits and starts. 9:49 But certainly at Optum, I come from the consulting division where we really focus on people, process technology. 9:55 I am not a technology expert myself, but we do have within Optum different solutions and one of those that we do within our partners and offer in the marketplace is a specific solution around authorizations and automating as much of the process as possible. 10:12 I can tell you though, just representing the industry more broadly and not specifically for our our solution, there are limitations in what we can automate in the automation space today because of the unique nature and the clinical information that's required differs from each payer where how much information, how they want you to submit it. 10:30 And so there's a lot more authorization automation happening in identifying which patients actually require a prior authorization. 10:38 I think that piece has been something where we've really seen some advancements and some true gains in technology really helping to change the workload of what must be done via a team member or a staff. 10:50 Similarly on the back end, some good automation capabilities that exist in going out and scraping where you do have those portals to identify if Samantha is scheduled for a hip replacement and we've submitted for an authorization, has the authorization been obtained? Has the payer actually provided that? And going out and grabbing it, if it in fact does exist and pulling it back into the electronic health record 11:12 So I think those have been really helpful pieces. 11:15 The other place that we have seen some automation success is for those payers who are preferring phone calls to obtain the prior authorization. 11:24 There's been some success in leveraging automation and being able to complete those with some of the computer assisted calls that we can make. 11:35 So I think definitely some advancements, but there is no one silver bullet panacea from A-Z of I can completely, you know, reduce or automate my entire authorizations process yet. 11:48 I think that would be great. 11:50 I think that's where we're really hearing from our client partners. 11:52 They're really looking to reduce the administrative burden as much as possible. 11:57 I'm actually with some clients here in our Optum headquarters in Minnesota today. 12:02 And in fact, just this morning, one of our revenue cycle participants in the forum comes from a large children's organization in the area and just mentioned they had to add 30 team members to deal with the rising prior authorization requirements within their health care center. 12:17 And that's huge. 12:19 It's really challenging to be able to maintain any sort of financial bottom line success from a margin perspective if you have to add 30 team members year over year to tackle the rising prior authorization requirements. 12:33 And so I think that's where we really have to continue to push as an industry on how can we have the right prior authorization requirements, number one, right? 12:42 But then how do we automate as much as possible so we can really have the team members who are completing this function in a role. really only be doing the work that must be done that cannot yet be automated and having them work sort of top of license, if you will. 12:57 Great. 12:58 Christine, how was your experience at Northwell kind of aligned with what Samantha just said? 13:06 Yes, I mean, I can, I think Samantha did a great job covering it, you know, from a health perspective for sure. 13:11 One of the things that I will talk about here is that in Northwell, so unlike Savanah, we haven't moved to Epic yet. 13:17 We're on our Epic road map, you know, heading there with the first wave going live in November. 13:22 So we have a lot of inter-operability and multiple system challenges. 13:26 So even if we can find the right solution that's out there, can it talk to all the different systems that we are utilizing and be able to leverage that data? 13:34 So that is definitely some challenges that we've had here. 13:36 And then, you know, all of us operate on very small margins. 13:40 So the cost of some of this automation and some of those systems, you know, so really making sure that you have a strong ROI or that you know, that you really understand what, that you know what that vendor or what that application is going to be bringing to you. 13:54 And then any kind of technical, technological difficulties. 13:56 So, you know, these systems are great as long as they're up and running. 13:59 You know, we all went through, you know, the issues, you know, earlier in the year with, you know, with Change being down and stuff like that. 14:06 So like, you know, you just sit there and you realize how reliant sometimes we are on these applications that when you do have to go back to pen and paper, like what a large challenge that is for you. 14:17 And then, you know, data security, like, you know, just to keep talking about that. 14:20 And, you know, so what is the security challenge? 14:22 You know, we've had here at Northwell, some of the vendors that we've brought forward can't meet the liability requirements that Northwell's putting on the table now. 14:30 It's, you know, with so much breaches and so much, you know, new things happening there. 14:34 So those are all things to talk about. 14:36 And then that over reliance on technology, but also sometimes, you know, depending on payer, one of the things that we found is that, you know, those people inside the practices that don't do this as a dedicated job, you know, the secretary and you know, besides answering the phones and checking people in, I also do my providers authorizations. 14:53 Those people are harder to buy into some of these technologies or some of these wrap arounds because they don't know for this payer, I can do this. 15:00 And for that payer I have to fax and for this payer I have to call. 15:02 So then they just default to like the manual process, you know, and then they just start calling because they can't, they feel like they can't rely holistically on these tools because they only work for the bigger payers. 15:14 That's that like digital divide that kind of exists out there in the place. 15:18 And then we're starting to experience, you know, some places where we've had put some automation in place, some of the payers are now countering it with bot blockers, you know, so now some of our RPA technology and stuff like that is now starting to fail. 15:33 So where we've invested in building out some of these workflows, we're now finding that they are not working. 15:40 So even more to Samantha's point is now we had a conversation earlier in the week with people that could do the automated phone calls for you because that seems to be one place that maybe you can get around those bot blockers that are out there. 15:52 But once again, new investment, more money, more technology. 15:57 And you know, our most senior leadership gets very, very frustrated. 16:00 They're like, there needs to be a better way. 16:04 Thanks, Christine. 16:06 Savanah, can you tell us about some of the technologies that Ochsner is using in in terms of prior authorization? 16:12 Yeah, absolutely. 16:13 I think Christine and Samantha did a great job kind of explaining some of the challenges that we see in general, you know, technology as a hindrance. 16:24 I think just ultimately it, it lies within the complexity of the prior auth process and that there is no standard way to connect to all the payers. 16:35 You know, I touched earlier that we are an Epic Shop and it's really important for us to stay current with adopting that the Epic functionality. 16:42 Some of the tools that we're using right now with an Epic for our prior authorization automation is our auto-statusing. 16:50 So this allows us to call out certain procedures for certain payers that we know don't require auth, so that the system will automatically authorize those and leave you know freeing up our our reps for those higher value activities where they really do need to submit. 17:06 And then a big undertaking over the last couple of years has been going live with payer platform with an Epic, specifically electronic medical prior authorization, which allows us to connect directly to the payers within Epic. 17:21 And so the system can automatically determine if an authorization is required without even a user having to take any actions. 17:29 And then if it's not, you know, the system will authorize that referral. 17:34 If it is, then you know, we'll have a user go and submit the documentation that's needed. 17:39 I think the drawbacks to electronic medical prior auth right now is that there are not a ton of payers connected to the program. 17:49 So you know, we're connected with a couple of payers. 17:54 We're going live with our Blue Cross Blue Shield of Louisiana at the end of the year, which is going to be a big lift for us. 18:00 But I think that's a real drawback is that we're not able to connect this way to all of the payers and and see that big volume that we would like. 18:12 Great. 18:12 One thing I would just add as well on this topic is, you know, coming from from an organization that has the opportunity to provide services to provider organizations. 18:21 I think prior authorization as a pain point comes up in every single client partner that I have the opportunity to connect with. 18:27 And so this is absolutely an area where Optum is investing quite deeply and how can we help be a better partner in A-Z of the prior authorizations where right now we have some capabilities and we'll call it like A to F, right and then some capabilities in the back from like W to Z. 18:43 But that middle part right is still quite manual. 18:46 And we have the benefit at Optum Advisory of working with a fantastic global team across Optum. 18:53 And we liaise particularly with some of our colleagues in our Ireland Optum office to create complete customized automation where we don't have some of the limitations of, you know, traditional more templatized products that have some of the, you know, to Savanah's point, pair limitations in terms of connectivity or things like that. 19:13 So we are working on solutions to be able to bridge the gap and be able to help reduce the administrative burden wholly. 19:19 I think we're not there yet. 19:21 So happy to talk with folks who are interested further about what could that look like and how do we get there. 19:27 But that is absolutely an aspiration and something that we're working on. 19:31 I think for now, there are certainly benefits in some of the upfront pieces and some of the some of the back end pieces. 19:37 You know, as I thought about as Christine was mentioning some of the secretaries in different roles, one experience that I had with a very large health system that I was working with in the Northeast, they had over 300 discreet ambulatory clinic locations. 19:52 They did not have centralized authorizations. 19:54 It was one of those kind of Jacks and Jills of all trades and it was their medical office assistants who were performing the roles and we had the opportunity. 20:02 To do some data tracing and some workflow observations to understand what was working well and what wasn't. 20:09 When we sat behind some of the medical office assistants in a few of their different surgical specialty clinics, we actually saw Post-its, for this patient needs a prior authorization. 20:20 This patient doesn't. 20:21 We observed some of those staff calling every single patient on the schedule to determine whether an authorization was needed. 20:28 And when we inquired, well, how often of those patients are you actually needing an authorization? 20:33 20 to 30% 20:35 Well, if we think about that, 70 to 80% of those calls are essentially wasted effort. 20:40 But it was something that the organization had to do as what I call a CYT, cover your TUSH, strategy. 20:47 Because if you don't do that on the front end and then you miss the prior authorization on the back end, fewer and fewer payers are allowing for retroactive authorization. 20:56 So to prevent that revenue leakage on those write-offs, so much work was being done that really didn't have any value to just even identify this is the work list or this is the pool of patients that do need a prior authorization. 21:10 And that's where at Optum we are helping organizations kind of with that funneling and making sure that the work that you're doing is at least the valued work where you really truly do need a prior authorization prior to providing patient services. 21:23 So that way you're not only reducing the workload for all of those calls. 21:26 But to Christine's point, I mentioned a lot of the work that I do happens to be focused on consumerism and patient experience. 21:33 We don't want to delay unnecessarily putting patients on the schedule and providing downstream services for authorizations if they don't need one. 21:42 But we know when we do need an authorization, we rarely can get it overnight. 21:45 And so sometimes we wait a week, two weeks to put patients on the schedule to give us time to obtain those prior authorizations. 21:51 If we don't have those limitations or requirements for a particular payer based on their services that they're receiving and their insurance coverage, allowing us to get them in the door as soon as the reasonable clinical access capacity allows. 22:07 I think that's a great lead into our next question, which is how should revenue cycle leaders assess and select vendors to handle prior authorizations? 22:16 What questions should you ask in advance? 22:18 And Christina, if you want to start, that would be great. 22:21 Yes. 22:21 Yeah, so usually whenever we're asked these kind of questions, you know to me, I think we always should start with like a needs assessment. 22:26 So really define that specific need or pain point. 22:30 So what is our biggest challenges you're facing with your current authorization process? 22:34 Where do you experience the most delays or most denials? 22:37 Are there specific specialties or payers that are causing the most problems? 22:42 Then I think you should always look into your current cost. 22:45 You know, I think a lot of times we're always just trying to look for the future solution, but sometimes we really have to understand what our current state really is and then determine our outcomes. 22:53 You know, so what are we hoping to achieve with this new technology? 22:56 Are we trying to just reduce administrative burden? 22:59 Are we trying to speed up the turn around time? 23:01 Are we trying to improve our authorization rates? 23:03 Are we trying to increase revenue, decrease denials? 23:06 I think one thing that we try to do here a lot is make sure that we involve all key stakeholders. 23:11 So gather the input from your physicians, from your nurses, from your billing staff, from other relevant stakeholders into what their issues are. 23:19 So that way we're not just taking it from a revenue cycle perspective, but we're taking it from a holistic system perspective. 23:25 And then do some research on your vendors, talk to colleagues, talk to other people across the country, you know, create a potential list of vendors, you know, do some research on it on your own, you know, understand what systems you're in. 23:37 So maybe somebody really interacts great with Epic, but maybe they're not so great with, you know, Sorian or Athene IDX or other systems that are out there that may be part of your part of your, you know, footprint. 23:49 We always ask for, you know, we do RFPs here. 23:51 So we're a very formal process, but we always ask for demos and presentations. 23:56 And one of the biggest things that I do is I always try to make sure that I bring the subject matter experts in because I have found that a lot of times vendors say yes or promise things that they cannot deliver, you know, so if the payer can't do it, how's the vendor going to go find it for you? 24:11 You know, so if the, if the payer is not telling you that this authorization is for an impatient stay or is for the ASC or is for these specific, specific CPT codes and the vendors telling you like, "Oh yeah, we can do that." 24:22 You have to really know what you're asking them to do and be able to call their, you know, their poor responses or what I would say their BS responses, you know, out to say like, but explain to me how you're going to do that because today I can't even do that manually. 24:34 So, you know, what's the magic behind your source? 24:37 And then I always check for references, you know. You know, call your colleagues, you know, talk to people. 24:42 And sometimes, you know, I always ask them for references, but then I also try to reach in and say, who do I know that possibly uses this? 24:49 Because I like the backdoor references more than the former ones because generally those really have good relationships and usually will find, you know, just high praises and things like that in there. 25:00 And then when the vendors actually come in, you know, what are those integration questions? 25:03 You know, what's the functionality questions, You know, what are the usability? 25:08 So how can you make sure that it's really going to fix what you're trying to solve? 25:13 And then of course, you know, cost and ROI, security and compliance, scalability and flexibility. 25:18 You know, so a lot of times we do stuff in small pilots here, but will it work across the board? 25:24 25:24 We see a lot of people doing space in the radiology space, but they're not doing stuff in surgical spaces, you know. 25:30 So how do you fill all of those voids? And then implementation and support. 25:34 So like what happens, you know, how do you implement? What's your ongoing support? Not only from a initial point of view, but from an ongoing cost. 25:42 And then if there's changes that happen, we know this space is constantly being reconfigured and constantly getting, you know, stuff put in and out of the authorization space. 25:50 So how quickly can they scale up and make those changes for you? 25:54 Payer coverages, how many, how many payers do they actually provide coverage for? 25:58 And is it back to the list that you created is our biggest pain points, you know, with you know, payer AB and C and is this product or is this vendor going to help us in those spaces? 26:08 And then any kind of future development, you know, is there somebody that's willing to partner with you? 26:12 You know, a lot of times we have great ideas. 26:14 You know, is there somebody that's willing to, you know, sit down and really kind of plan out and invest in improving their technology where almost all of their clients can benefit? 26:23 And then negotiations and contracts and implementation and then support, you know, so those are the things that come top of mind to me. 26:32 Very informative answer. 26:34 Savanah, do you have anything to add? 26:36 I think, Christine, you did an amazing job answering all of the things that I really wanted to touch on. 26:41 I think, you know, it's really easy to be enamored by all the shiny options that vendors, you know, say that they have to offer to us. 26:48 But, you know, you really have to identify what the challenge is and the need that you're trying to solve for. 26:54 You know, really the only other thing that I have to add when we're looking at a vendor, because we are integrated with an Epic, as I've mentioned, is as we always ask the question, is this something that we can build with an Epic or, or do we actually truly need a vendor? 27:08 Or even if it's not something we can do right away, can we, you know, get with the Epic Wisconsin folks at headquarters and see if this is something for a potential release in future upgrades? 27:20 So, yeah, so I have a question that's off script, but can either of you tell me about the response when a vendor fails to deliver what was promised? 27:36 Yes. 27:37 So I'll tell you. 27:38 I mean, we've been through it a couple of times, you know, so sometimes we'll ask them, you know, what is it going to take to remit a rate? 27:44 And then a lot of times I'll stop paying them, you know, we'll just literally call procurement and say until this is resolved, you know, we're going on a non-payment, you know, to try and get attention and try and get stuff around it. 27:57 I'll escalate with inside Northwell to make sure that my leadership understands the decisions that we've made and also escalate with inside the vendor themselves, you know, so that we nobody's surprised that, you know, that we're not getting, you know, we're not getting the right support from your support team. 28:11 Our salespeople are usually the strongest people to get stuff moving because it's usually their bonuses and their, you know, their actual paychecks that get affected by my lack of payment. 28:21 So generally those are some of the first phone calls I make. 28:28 Yeah, and I totally agree. 28:30 I think obviously it's important to delay that groundwork ahead of time for those check ins and setting those expectations. 28:35 And to Christine's point, that should not be a surprise to anyone if you're doing those. 28:40 I think it it's important to recognize when you're failing, we always say fail fast. 28:44 You know, we're not going to draw something on that we know is not providing a benefit to us. 28:49 And, and recent, you know, we have had to do that with certain vendors and you know, kind of just recourse and go a different way. 28:59 And Samantha, do you have any advice for revenue cycle leaders about selective vendors? 29:04 Absolutely, completely agree. 29:06 Christine did such a fantastic job. 29:08 In fact, in my role, I have the opportunity to work with our client partners in formally setting up vendor vendor management selection committees for various topics and prior authorization, maybe one of them. 29:19 And many of the steps that Christine recommended are inherently part of that process, right. 29:24 In terms of whether it's a formal RFP process, we often run it even as formally as it would be at an RFP, even if there isn't a formal procurement limitation. 29:33 And so 29:34 Thinking about the capabilities, the references, all of those are absolutely spot on. 29:39 I think specific to prior authorizations, a few other considerations that we often encourage folks to think about is what is the upstream and downstream integration of the prior authorization capabilities? 29:50 For example, what services require prior authorization really depends on what the services are themselves and then what the insurance coverage is. 29:59 So connectivity with your insurance verification and eligibility is really important. 30:04 So we look at that pretty critically. 30:06 And sometimes there may be just different partners. 30:09 You may not always have the same vendor who is your eligibility vendor and your prior authorization. 30:14 And that's OK. 30:15 But you certainly want to understand what are the technical interfaces, how well can these systems communicate to make sure the information flow is going to be supportive of the process working as it should to prevent that situation that you just talked about where we've all had sort of a bit of a false start with the vendor. 30:31 The other piece is just how will that solution integrate back with your electronic health record? 30:37 Certainly, you know, we're talking a lot about Epic today, but we know not everyone's on Epic. 30:42 A very large portion of the country is. 30:44 But whether it's Epic, whether it's, you know, Cerner, Meditech, IDX, you know any of the other systems out there, can the the technology partner actually integrate back in and pull the information back into the core system so that you can understand for your end users, what is it the workflow going to look like? 31:03 Are they going to be working in Epic or are they going to have sort of a bolt on and an additional screen or application that they have to leverage? 31:11 And then the last piece of counselor advice that I would give here is oftentimes in the situation that we find ourselves where so many organizations, I think, I think I just saw a statistic this morning that 37% of hospitals are reporting negative margin or anticipating negative margin performance in 2025. 31:30 When that's the case, budgets are tight. 31:33 Budgets are always tight in health care, let's be honest, but they're exceptionally tight when that's the case. 31:37 And so the inclination or the push can be to really focus on cost and looking at just sort of comparing fees to fees instead of really looking at value and looking at return on investment and thinking about, OK, let's just say in the example I gave earlier where one client partner just had to add a team of 30 FTEs for prior authorization, right? 31:59 How much of that workforce can we reallocate to more value-added patient-facing tasks versus this sort of insurance facing internal administrative function? 32:10 How much of that can we avoid sort of manual labor costs? 32:13 And in most cases, it's really not, we don't need these resources. 32:16 It's we really need them desperately somewhere else, whether that's scheduling or arrival or financial advocacy. 32:22 So thinking about that and then also thinking about what is the benefit that you can yield in terms of your outcomes? 32:28 So how much are you spinning your wheels on the back end because you didn't obtain a prior authorization or you obtained a prior authorization for the wrong service? 32:36 Maybe that was just an error. 32:38 Maybe the clinical circumstances really required that a different procedure was provided. 32:43 And it's not one of those where you can sort of get the bundled authorization. 32:46 But all of that rework to ultimately then determine what is your final denials or write-off performance, How much money are you actually losing and uncompensated care that you provided didn't get the prior authorization or didn't have the right one and couldn't work through it on the back end with the payer. 33:01 And ultimately we're not paid for those services. 33:04 So that's really the value equation as opposed to the cost equation. 33:09 It's much tougher to get at the value and the return on investment, right. 33:12 There's a lot of data elements that are sometimes tricky to get to. 33:16 Maybe there's not resources to help pull that together. 33:19 That's some of the value that we provide when we are coming in and helping run a vendor management selection committee is thinking about how do we really compare apples to apples in terms of cost, but also outcomes and value and not just looking solely at cost. 33:34 Because sometimes that's where we have seen some of those false starts, right? 33:37 Where we thought we were going to get something and it almost sounded too good to be true. 33:41 And then in fact, maybe perhaps it was. 33:45 Thank you, all great answers. 33:47 Let's move away from technology. 33:49 What are some non-technology related strategies for improving the prior authorization process? 33:54 How are they integrated into revenue cycle workflows to cause as little disruption as possible? 33:59 And Savanah, if you want to start. Sure thing. 34:03 You know, I think prior to relying on technology and automation within the prior auth space, we really had to focus on our foundation for a solid prior authorization process. 34:13 And we've talked a lot about centralization and that's kind of what it looked like and how it started for us. 34:18 So we did create, you know, that centralized prior authorization team where the teams are grouped by service line, which, you know, allows those team members to really become experts in those services that they're obtaining prior auth for, become more familiar with what's required. 34:35 You know, within those workflows, we implemented standardized communication. 34:39 So, you know, we're consistently communicating with providers if we don't have that prior auth in time with patients, if we don't have that prior auth in time or if it ends up being denied, you know, best practices for documentation as well. 34:52 So ensuring that the way that all of our team members are documenting within the status of the prior auth is all the same, the providers know what to expect. 35:00 They know how to look up the status kind of where we're at. 35:05 Again, having that really strong communication with your providers is super important and the patients as well. 35:13 And then you know, another part is we talked about the back end. 35:16 Our prior authorization team really just focuses on submitting the prior auth. 35:20 So they're not doing any reviews of denials or payer changes. 35:23 And so we have other teams within revenue cycle that are helping us with that. 35:28 You know, our revenue cycle financial analysts are consistently staying on top of prior auth requirements and changes and sending those to us on a, you know, monthly basis or weekly if necessary depending on how the payers are getting that information to us. 35:43 You know, we rely on our denials team to help us identify where there's opportunities, where we can do better on that on the front end and capture those. 35:52 You know, kind of like Samantha was saying, we're finding that value on the front end as opposed to being reactive on the back end. 36:04 Yeah. Thanks Savanah. 36:05 Samantha, can you tell me about some of the work that you do with clients on non-technology processes? 36:11 Sure. 36:11 Well, there's many different things. 36:13 And as you all have gathered by this point, I have the gift of gab. 36:16 So I'll focus just on one which is engaging patients and understanding how prior authorization may or may not impact their care. 36:25 You know, we who live in health care operations and revenue cycle and finance, understand prior authorizations. 36:33 We may not love it, but we understand it. 36:35 But patients often really don't have much exposure to prior authorizations until they are personally impacted. 36:42 Maybe they need a particular, you know, service and their insurance has has declined their prior authorization request and that's their first understanding of it. 36:51 So thinking about how can we proactively engage and educate patients when we are referring them for services, when we're communicating with them to help them understand this may impact them and to also help them understand how prior authorizations work. 37:07 Unfortunately, you know, health care providers often bear the brunt of patient frustration around prior authorizations because they don't really understand the connectivity between prior authorization requirements that are set by their insurance plan that they've selected. 37:22 They often think that it is the doctor's office or the hospital. 37:25 And we certainly don't want to kind of play the blame game, but we do want to help patients understand where this all originates from so that they can also be their own advocate and be engaged in the process. 37:37 Because sometimes if a patient calls and engages with their health insurance plan, if their provider is seeing a difficulty or a delay in obtaining an authorization, it can really help move the needle. 37:49 So helping to patients to understand what the prior authorization impact may or may not be early in the process and then continuing to educate them on how they can be a part of it. 37:59 I think in an ideal environment, we, we kind of liken this part to being a bit of a duck where you're calm on the surface, but kicking, kicking, kicking underwater. 38:09 And we talk about this in terms of a patient experience, firewall, ideal scenario, perfect case situation. 38:16 The health care provider can navigate all of this and we never have to expose the patient to it. 38:20 It all just kind of happens like clockwork and to the patient we're that duck. 38:25 But we are as the health care provider kind of the legs kicking, kicking, kicking under the surface. 38:30 The reality is we're not quite there yet. 38:32 So if we can help patients anticipate where there may be delays, where there may be challenges, we find that their experience and their outlook is much more positive. 38:42 If it doesn't come as a complete surprise and they don't quite know what we're referring to, they don't know how to navigate the situation because it's something they feel unfamiliar with. 38:53 Thanks, Samantha. 38:54 Christine, can you tell us about the non-technology related processes at Northwell? 39:00 Yeah, thank you. 39:00 And I agree with Savanah. 39:01 I look forward to the day when we're able to centralize and have an authorization staff that's an essentialized process. 39:07 I think that'll improve Northwell's workflow completely. 39:10 But in today's world because we are decentralized, I think one of the biggest things that we have to do is make sure that we learn and share from all the individual practice operations. 39:20 So if somebody learns, you know, what's getting denied or what's getting approved first pass, how do we share that across the organization and how do we ensure that everyone learns from the wins and also the struggles so that, you know, we can end up with the best practice type of model. 39:34 And that goes to also it, you know, Savanah was saying with, you know, standardizing forms, you know, providing clear documentation for medical necessity and you know, trying to come up with a single process even in a decentralized point of view. 39:47 And I also very much agree with Samantha, the more we pull our patients into it and how do they advocate for themselves? 39:53 But one other piece that you know, we've attempted here at Northwell, sometimes successfully, sometimes not, is getting stronger payer relationships. 40:01 You know, so how do we have open a communication channel with our payer representatives and really talk to them about issues that we're having either with turn around time or 40:10 You know, lack of clarity on what needs to be authorized and what doesn't, you know. So instead of trying to live in that gray space, like how do you open that dialogue and really explain to them 40:18 You're telling us, you know, this needs to be done, but we're trying to do that and we're not successful. 40:22 So like, what are we missing? 40:24 So how do you not go back to the source and say you need to clarify this for us? 40:28 And then, you know, and then we really have a very strong appeals process. 40:32 So even if, you know, some stuff gets denied. 40:34 So we end up with a lot of issues with add-on procedures. 40:37 You know, so we had the primary procedure authorized, but now once the surgeon was in there or once the patient was on the table, the doctors have decided to do more care. 40:46 So how do we ensure that that documentation is robust enough and how do we really appeal through that medical necessity point of view that it was the right thing to do for the patient while they were on the table and really ensure that our clinicians are documenting as strongly as possible. 41:01 So that appeal process has a much stronger ability to to potentially get us paid. 41:08 Thanks, Christine. 41:10 You've all touched on this next question, but hoping you can elaborate a little bit on 41:14 How can revenue cycle teams collaborate with payers to improve the prior authorization process? 41:22 So Savanah, would you like to start? 41:24 41:26 You said Savanah? 41:27 Yes. 41:28 Absolutely, yeah. 41:29 You know, Christine kind of just touched on this, but it's, it's really important to have and establish a strong working relationship with the payers. 41:37 One of the ways that we do this is through a monthly joint operating committee that's led by our managed care team where we do get to discuss standing issues, hear from the payers, really have that collaboration. 41:49 And you know, we've talked a lot about adopting automation and implementing there. 41:56 One thing that's really been crucial to that is looping the payers in and having a dedicated contact when you do want to put automation in place for a certain payer. 42:06 I think being that we have been on payer platform and that was established through Epic, that made it a little bit easier for us. 42:14 But dedicated payer contacts are really crucial to your success. 42:19 And then you know kind of on the back end, our revenue cycle denials and our analytics team, they really help identify reoccurring patterns in our prior auth denials. 42:29 So we'll work directly with the payers in those scenarios to mitigate those as well and help kind of see where we can improve. 42:39 Thanks, Savanah. 42:40 And Christine, do you want, do you want to answer? 42:42 No, I mean, Savanah's right on point there. 42:46 I think the biggest thing is really trying to figure out where you can share goals. 42:49 So, you know, it's an administrative burden on both sides of the fence. 42:52 So where are there places, you know, where you bring those analytics and you bring that experience to the table and say, "Hey, listen, you're denying these upfront, but after we jump through this super, we have a peer-to-peer review or we, we have this done, you're then approving it." 43:07 So like, why are you driving up your, your, you know, administrative cost and ours? 43:12 So how can we, you know, collaborate and really come together on that first pass approval rate? 43:19 And then also, you know, you know, Savanah spoke about this, but really bringing, you know, that information really explains to them where they are nowhere near their peers, you know, so are you asking for authorizations at a much higher rate than everybody else? 43:33 Like your your scope of authorization is, you know, bigger than everybody else's or sometimes, you know, asking for authorizations for procedures that aren't that expensive, your reimbursement rate's so low. 43:45 So why are you asking us get an authorization on something that is equal to an office visit that you don't ask for authorizations on? 43:51 So how do you challenge some of that process to it? Requires a lot of a lot of information, a lot of data and a really close relationship. 43:59 So making sure that your managed care team is involved because, you know, depending on where they are in the contracting process, you know you could either be opening or closing doors on the bigger picture. 44:09 So sometimes you, you know, have to make sure that you're looking at the organization's best interest and not just yours from and you know, from your revenue cycle space specifically. 44:21 Samantha, your thoughts? 44:23 Sure, I would. 44:24 I would echo Savanah's sentiments around mining data. 44:29 We are really focused. 44:30 I mean, as consultants, of course we love data and we're thinking about how can we have data-driven insights to meaningfully inflect performance. 44:38 I think often there's an opportunity to better unify revenue cycle and managed care contracting, which are often not driven by the same leaders to really say how can we make sure that we are not just going to managed care contracting tables and fighting for, you know, certain rate increases, but that we're actually addressing the problems that we're having systemically from a process perspective as well. 45:00 And thinking about some of the, you know, one of the things we'll do is we'll have vendor scorecards around where are we seeing the most challenges in obtaining prior authorization? 45:09 Where are we seeing the most challenges in initial denials? 45:12 But then to Savanah's point, perhaps we're not really seeing write-offs. 45:15 So there's just a lot of rework, right? 45:16 You're paying us, but we're doing all of this work. 45:18 You're doing all of this work. 45:19 And then we're, we're kind of seeing it's, you know, 0 sum game. 45:23 So thinking about how do we take that data back to the negotiating table in a meaningful way? 45:28 And then, you know, one of the things that I often joke that everything old is new again, kind of like build it, keep it in your closet, it'll come back in style. 45:35 I'm personally a huge, a huge fan. 45:37 But one example of this is Gold cards. 45:39 They're not new, but they're sort of back in vogue where some payers will say, you can obtain a Gold card and essentially we will let you pass go without collecting $200. 45:49 We will waive the prior authorization requirements for providers that meet certain eligibility requirements. 45:55 And where we've seen that the data supports, you know, we are essentially doing that, right. 45:59 We have a lot of rework, but we're getting paid. 46:01 So you know, you're providing care that is truly medically required, right? 46:06 We're not seeing a big, a big write-off  for lack of prior authorization after all of that process has been said and done. 46:13 And so I think that, you know, people love or hate that idea. 46:16 It's certainly a polarizing topic, but that's something that we're seeing as well. Great. 46:23 So we've talked about relationships with payers. 46:26 What about relationships with providers? 46:27 How can revenue cycle teams collaborate with clinicians or other hospital professionals to address prior authorization issues? 46:37 Christine, would you like to start? 46:39 Yeah, sure. 46:40 So I think some of the stuff that we do here at Northwell is trying to be as transparent as possible, you know, make sure that everybody understands the process. 46:48 I think we do a better job with our employed physicians that, you know, also wear the Northwell badge. 46:52 Then our voluntary faculty, which are just as important that come in and use our ORs or use our cardiac cath labs to make sure that they understand the processes that are necessary. 47:03 So being able to hold town halls or to have representatives that go out into there and explain to them the reason why these authorizations are necessary and any denials that we may be getting on their cases, you know, so cross-training, you know, making sure that they also have people making sure they have a point of reference. 47:17 So if they have questions, do they know where to call? 47:19 And we're not just giving them some 1-800 number that they actually have a human that could be a representative for them. 47:25 Any kind of feedback mechanism. 47:27 So things that they may or may not be doing properly. 47:30 So I think where revenue cycle, 47:32 We always tend to talk about the stuff that isn't working, but I also think it's really important to give people feedback on the stuff that does work and to celebrate the the wins. And then, you know, I think proactive problem solving. 47:45 So what are the issues that we're having? 47:46 But also what are the issues that you're having inside of your offices? 47:50 You know, if you're going to come in, you know, and that way you can get a bigger crowd of people that help go to the payer or help go to the hospital administration to change, you know, struggles that you're having. 48:03 I think wherever possible, integrate the technology, you know, so how can, you know, how can those voluntary faculty send stuff that the hospital knows that the authorization's there? 48:12 You know, we employ a large team of people that just validate that authorizations are in place because that hospital bill is really large and you just don't want to take people's words at it. 48:21 So, you know, so a lot of times we have people on hold just saying, "hey, I see Christine's coming in for surgery next week at, you know, this hospital and I see an authorization's on file. 48:31 But can you tell me exactly what that authorization is for?" 48:34 And, you know, you think about it, it's like it's crazy to think that you have to do that. 48:38 But, you know, you're surely not going to put, you know, a big hospital bill at risk, you know, expecting that the voluntary staff continue to do that. 48:46 And I think, you know, monitoring stuff. 48:48 So once again, similar to the way you would go to the payer is you also want to go to your clinicians and say you want to know something, 48:53 We're getting more denials on your cases than others. 48:55 Let's walk through why that's happening. 48:57 And maybe they're not authorizing the right CPT codes or maybe they're not authorizing the right site of service or, you know, any of those reasons that you give the payer to be able to deny stuff. 49:08 So I think the more transparent, the more open communication and the more you go in a, how am I here to help solve this for you or help, you know, how can we work on this together, point of view, the better because that is, you know, not trying to blame people and not trying to, you know, point fingers. 49:25 But like, how do we collectively make this better for all of us? 49:31 Great. 49:31 Thanks, Christine. 49:32 Savanah, do you have anything to add? 49:35 Yeah, I know I think the collaboration piece is, is really key, being that we are on that centralized model. 49:40 We do a lot of education with our physicians and our clinicians that are kind of beginning that workflow and closing the loop on how the impact of their workflow impacts, you know what we're able to submit and and the approval timeline of the prior auth. 49:55 So we really stress the importance of the timely and accurate documentation with those physicians. 50:02 We also provide educational services that maybe don't require prior auth. 50:06 So they know that which services they can schedule really quickly, as opposed to which services need to be scheduled further out. 50:11 So that we do have that time. 50:13 We've implemented, and we did get this idea from one of our peers, 50:17 We implemented a centralized peer-to-peer model recently. 50:21 So we do have a physician advisor that is and we did, you know, pilot and, and one certain service line and we are expanding, but a physician advisor who is handling all of those peer-to-peers. 50:32 And that really helps with the buy-in of other providers, if those providers are getting that information from, you know, a physician peer. 50:40 So helping us identify those trends to really prevent those peer-to-peers and and get that approval in the beginning. 50:47 And then, you know, another workflow where we've kind of looped in our clinicians as we implemented a medical urgency workflow. 50:55 So we were seeing a lot of visits that were marked medically urgent and we would let the patients go through without prior auth. 51:02 We're never going to hold up those patients. 51:03 So what we started doing was flagging these cases. 51:06 We would loop in the physicians that are involved in these cases, the CFO at that facility and really help us make a decision if the visit is truly medically urgent or if we can kind of delay to get that prior authorization in place prior to seeing them. 51:23 Thanks, Savanah. 51:24 Samantha, any thoughts on those answers? 51:27 Completely echo and agree with everything that both Christine and Savanah had stated. 51:31 I think the only other few items I would quickly add are, you know, we are engaging clinicians more in being part of the actual solution and process. 51:41 So I think it was Christine earlier who mentioned oftentimes we're thinking about prior authorizations more from sort of 'I've got a procedure scheduled that requires a prior authorization', but medications are increasingly becoming a large component of the prior authorization picture as well. 51:56 And so more and more we are seeing organizations that are dedicating nurses or LPN clinicians to help support that process and help us be successful with some of the clinical knowledge that's required to succeed there. 52:08 We're also seeing organizations think strategically about how to have clinical involvement in the appeals process, whether that is dedicated nurses that are part of the denials team to help us think through how do we navigate, and hopefully prevent, needing to have true peer-to-peer for some of the post-care delivery situations. 52:29 Although certainly we know we can't always prevent that as well. 52:33 And then I think just engaging with the actual provider clinicians, so your MDs, your advanced practice clinicians, to help them understand the importance of clinical documentation around prior authorization as well. 52:48 Because you know, we are talking about this predominantly from or, or a lot of the, the comments I've made have been predominantly from some of the hospital outpatient or ambulatory. 52:57 But even in the inpatient arena, thinking about things like continued stay authorizations and even some of those hospital outpatient or ambulatory, the documentation that the provider is writing to best reflect the acuity and severity of the patient really helps when we're thinking about obtaining those continued stay or procedural medication-based authorizations. 53:17 And so, you know, really engaging with the providers to help them understand what are the words that they need to use? 53:25 How can we help them understand? 53:27 I often liken it to we, we sort of set our providers up for failure and that it's like we, we invent a new board game, we give them the board game to play, but it comes with no instructions or how to. 53:37 And it's like just figure it out yourself, right? 53:39 So we really partner with clinicians around clinical documentation and it's not about writing more, right? 53:47 It's not about becoming a novelist because we know providers have limited time and are really being pushed to be as productive as possible and just have so many competing priorities. 53:56 So it's not just about documenting more, but it's about what are the words that we need to make sure that we're capturing so that we can truly convey the acuity and severity of that patient and the clinical need for the services that they are referring. 54:10 So those are some of the other ways I would, I would add as well. 54:14 Just one thing I want to add, if you don't mind for a second, that Samantha made me really think of is we also do the reverse. 54:20 We have the clinicians come in and educate us on new procedures and things that they are doing, so that we better understand what we're trying to get authorized, you know, so, and just even sometimes the basics like explaining to team members, what's the difference between an MRI and a CT scan? You know, what is actually an echocardiogram, what is a stress test, you know, so that you understand what you're calling about and what that patient is actually going to possibly go through. 54:44 You know, so our approach is different, our medication's different. 54:47 We know, why are we using this different drug? 54:49 So that way you have some basic knowledge and some basic information because if you're going to sit on the phone with the payer, you want to make sure you're speaking from a true place of true knowledge and not just what you Googled, you know. So what is what is the clinician really telling you? 55:04 Thanks, Christine. 55:06 For our final question, how will new technology or strategies improve the prior auth process down the road? 55:13 What's on the horizon? 55:14 And Samantha, do you want to start us off? 55:18 Sure, I think it's a bit of a strategy, but there is just a lot right now happening in the prior authorization space. 55:26 I think it's certainly a buzzword or hot topic in the industry and for very good reason. 55:32 And I mentioned I'm at an Optum event today. 55:36 One of the sessions we were speaking about this morning, in the state of the industry, was around how much activity there is at the state level around prior authorization reform. 55:46 And I think there is a lot of efforts to think about how can we, in some ways, get the right folks together from the payer/provider side. 55:55 And so I think we've touched on it, but I think payer/provider collaboration is just one of the biggest opportunities for our industry in the space of, we all want to make sure that we are being thoughtful about having the right kind of parameters to ensure that care provided is the right care for the patient and in order to maintain affordability of health care for everyone. 56:19 But I think there's still so much opportunity to do that more efficiently and more effectively. 56:23 So some of that can be, you know, instigated or initiated through some of the reform that's proposed and out there. 56:31 And I think that's going to continue because there is a lot of state driven activity with the prior authorization landscape. 56:39 So I think you know, one of the things that I will say is for folks in a revenue cycle role, prior authorization is sort of good job security because there's lots of running room for optimization. 56:50 I think there are certainly many best practices and I absolutely loved what Christine just said about having the providers come in and do education for the staff and the team members that are doing that. 57:01 So I think there's many different new tactics and strategies we can deploy, but I think overall, sort of the landscape and construction of how do we make prior authorization more sustainable for the health care industry is really one that has quite a bit of merit. 57:20 Thanks, Samantha. 57:21 Christine, do you have any thoughts? 57:23 Yeah. 57:24 So I, you know what, what scares me a little bit is like what's on the horizon or what's coming? 57:27 I don't think we sometimes know, you know, I mean, who would have thought that RPA and, and machine learning and AI and block chaining and these things would have been common terminology that we'd be using here in revenue cycle? 57:39 You know, I think some of it hasn't even been developed yet. 57:42 You know what's on that horizon, like how quickly these technologies came to us. 57:48 I think it's going to be amazing to see what AI really does, you know, like what a ChatGPT and you know, those types of things, you know, bring to the organization. 57:56 I think the evolution of value-based care, you know, So what is that really going to bring, you know, to the health care space? 58:04 And if we really do transition to that, you know, and then there's always the equity and access, you know, so like, what are we doing to ensure that everybody has, you know, access to care and has coverage? 58:17 So I think it'll be very interesting. to Samantha's, you know, what is our government going to put as far as regulatory? 58:23 You know, there's a ton of emphasis on health care, the cost of health care, you know, those types of things. 58:30 So, you know, I think we, we all think what's going to be on there. 58:34 But I can tell you that I definitely think some, some wild cards are going to come and that, you know, I do agree that prior auth is definitely, definitely gives job security. 58:45 I think, you know, revenue cycle in general, as long as we keep this super complicated, I definitely will be employed for a long time. 58:51 But I think some of it is still like, to be determined. 58:56 But I don't think you can read enough. 58:58 I don't think you can educate yourself enough. 59:00 You know, whether you like politics or not, we have to be involved in it, in this space. 59:04 Whether you like current events or not, you have to be involved in it. in this space and make sure the tech people around you are some of your best friends. 59:15 Savanah, can you close this out? 59:17 Yeah, absolutely. 59:18 I know we only have about a minute left, so I'll try to go quickly. 59:21 I think in terms of technology, something that we're excited to start exploring is generative AI within prior authorization. 59:28 So we're going to be going live with a template within Epic that will allow the system to automatically pull in certain documentation, clinical notes that is related to the service that we've had set up. 59:42 And then the system will start to determine automatically the documents that the teams are using for specific services and recommend them. 59:50 So I know that's something that we haven't really explored in the prior auth space, the generative AI and we're excited to kind of see what that looks like. 59:58 I think in terms of strategy, something that you know hasn't been mentioned today is. 1:00:02 We're seeing a big increase in our medical necessity denial. 1:00:05 So things, services that the payer will say, oh, it doesn't require prior auth, but then we'll get a denial for med necessity on the back end. 1:00:12 And we're trying to determine a strategy for that. 1:00:14 So for us that might look like educating our team on defining what the medical necessity is on the front end for services that maybe the payer says doesn't require auth. 1:00:23 Do we know that that's really something that we can get paid for? 1:00:28 Great. 1:00:29 Thank you, Savanah. We unfortunately do not have time for questions, but if anyone in the audience would like to submit questions, we can share those with our panelists and we will try to get answers for you. 1:00:44 That's all the time we have for today. 1:00:45 I want to thank our panelists once again for an excellent discussion and our sponsor, Optum, for making this program possible. 1:00:51 Finally, I'd like to thank you and our audience for participating. 1:00:54 Over the past several hours, we have heard from health care experts and our session sponsors about key strategies and tactics for tackling the future needs of health care organizations, as well as making sure you are set up for success. 1:01:05 We look forward to seeing you again for future Health Leaders webinars. 1:01:08 This concludes the Health Leaders Revenue Cycle Now online summit. 1:01:12 Thank you all.