Clinics faxed us their prior authorizations. Instead of asking them to learn a new portal, we built inside the one they already used every day, and it saved Bright $2.2 million a year.
Bright Health wanted clinics to stop faxing, and the obvious fix was a Bright portal. Our research with clinic staff showed they already had a login for every insurer and did not want one more. The one place they all worked every day was Availity. So we built ours inside Availity, where they already were.
When I joined Bright Health, nearly every prior authorization arrived the same way it had for decades. Someone at a doctor's office filled out a form and fed it into a fax machine. On our side, the review team typed every page back into our systems by hand. With over 2 million members, that cost added up fast.
The easy answer was to make clinics do the typing in a portal of our own. But that would have saved Bright money by adding work for front office staff who were already stretched thin. If the new way was harder than the fax, they would keep faxing. We needed something that was easier for them than the fax.
Clinic staff already logged into Availity every day, so we put our authorization tool there. If someone tried to log in to Bright directly, the page sent them back through Availity. Staff never had to learn a new place to go.
Staff had their own order for filling things out and their own shortcuts. We copied all of it, because a cleaner flow would still have been a new flow to learn. The tool also did lookups staff used to make by phone, like which of a doctor's locations was in the member's plan.
Our review team used real rules to decide each request, like how many hospital days were allowed and the 30-day look-back. We built those rules into the form, so a request could be decided the first time it came in.
Before opening it to every clinic, we tested it with one provider group. Their feedback shaped the release before everyone else saw it.
Because staff didn't have to learn anything new, they actually used it. 30% of providers were on it within three months, and 55% by six months, both ahead of target. Fewer faxes meant less retyping, and that saved Bright $2.2 million a year in processing. The answer turned out to be less technology, in the right place.
Pivots, an acquisition, and a 4.9-star outcome. A member app that pivoted into direct-to-consumer telehealth, then absorbed Zipnosis. I designed and co-facilitated the two days in Minneapolis that put both companies at the same wall.