Overcoming Patient Access Challenges: 4-Step Approach to Centralization

In a recent post, we explored the challenges healthcare organizations face with patient access, which create significant operational issues that impact revenue and the patient financial experience. To eliminate fragmented workflows and streamline processes, healthcare organizations can take practical steps to centralize patient access and implement an Integrated Financial Clearance (IFC) model.

Centralization, which involves the consolidation of front-end administrative functions such as scheduling, insurance verification, prior authorization and patient estimates into a single, standardized system or team within a healthcare organization, can help address these challenges. Centralized patient access is designed to improve efficiency, ensure data accuracy, reduce front-end claim denials, enhance the patient experience, and lower the cost of collection.

A phased, stepwise approach to centralization can help healthcare organizations avoid disruption, address workforce gaps, and build a scalable, technology-enabled model for success.

Step 1: Standardize Patient Access Workflows

The first step in centralization is to standardize patient access workflows. This involves identifying and documenting the ideal processes and technologies, then eliminating bottlenecks that can impede efficiency. For example, many healthcare organizations still rely on outdated systems or manual processes for eligibility verification and prior authorization, creating unnecessary delays and errors. Standardizing these processes, with the support of modern technology, allows teams to work more effectively and reduces the chances of claim denials due to errors.

Step 2: Implement Phased Centralization

Once ideal state workflows are standardized, the next step is to introduce centralization in phases. This approach minimizes disruption and allows for the effective allocation of resources. During this phase, healthcare organizations must evaluate their staffing strategy and identify gaps to centralize financial clearance operations. A hybrid model of in-house and global support, particularly for manual tasks like prior authorization, can provide the scalability needed to meet demand while ensuring compliance with regulations.

Step 3: Optimize Technology Solutions for Automation and Analytics

Once the ideal delivery model has been achieved, the focus shifts to optimizing existing processes and technology solutions. Technology solutions should leverage automation to streamline operations, reduce manual tasks, and enhance the patient experience. Automation tools for eligibility checks, prior authorization, and claims management can reduce errors and improve turnaround times. Additionally, using AI-powered analytics allows organizations to measure outcomes such as reduced authorization delays, proactively identify trends, track performance, and continuously improve patient access workflows.

Step 4: Measure Success and Drive Accountability

Centralization requires continuous monitoring to ensure it is delivering the expected results. Key performance indicators (KPIs) should be established to track progress and drive accountability, such as reduced authorization turnaround time, improved clean claims rate, and enhanced patient satisfaction. Regular performance evaluations will help identify areas for improvement and ensure that the centralization strategy remains aligned with organizational goals.

Download the white paper, "Transforming Patient Access: A Practical Guide to Maturity," to gain a comprehensive understanding of the four steps involved in centralization. Stay tuned for our final article in the series, which will focus on optimizing processes and technology solutions through strategic partnerships that streamline patient access processes, reduce front-end denials, and improve financial outcomes.