Physician Abrasion: An Understated Yet Crucial Concern for Payers
In today’s rapidly evolving healthcare landscape, the administrative burden placed on physicians has become critical. Provider abrasion—caused by excessive bureaucracy and inefficiencies—can erode the foundation of care delivery, leading to physician burnout, operational inefficiencies, and, ultimately, compromised patient outcomes. In an industry where every decision impacts care quality and cost, reducing provider abrasion isn’t just an operational goal—it should be an imperative for health plan leadership.
By taking bold action to minimize these obstacles, healthcare organizations like Centene can foster environments where providers are empowered to focus on delivering exceptional care. At the same time, member experiences are enhanced, and the system as a whole becomes more sustainable.
Our approach goes beyond reactive problem-solving. By proactively engaging with providers, we create a more supportive and streamlined process that balances efficiency, care quality, and cost control. At Avalon, one of the key pillars of our strategy is education within the lab landscape. Our team works closely with healthcare providers to ensure a clear understanding of the scientific evidence as the cornerstone of our lab policies and the translation into coverage determination criteria adopted by our health plan clients . This investment in education ensures the right tests for the proper care, streamlines workflows, and allows providers to focus on what truly matters—delivering exceptional patient care.
By proactively engaging with providers, we create a more supportive and streamlined process that balances efficiency, care quality, and cost control.
Beyond education, we recognize collaboration is a powerful tool for driving meaningful change. Through peer-to-peer consultations, we facilitate deeper relationships between our physicians and ordering physicians, ensuring that the most clinically appropriate tests are ordered. This not only improves patient outcomes but also reduces unnecessary procedures and costs. In doing so, we address one of the most pressing challenges in healthcare today: physician burnout.
Prior authorization plays a vital role in containing costs and managing utilization, yet it is often a source of frustration for providers and members alike. We are committed to making this process work more effectively without sacrificing care quality or patient experience. By implementing a more seamless and proactive approach to prior authorizations, we ensure that cost containment doesn’t come at the expense of the healthcare experience. Our efforts in automating these processes further allow providers to focus on clinical decisions rather than administrative hurdles.
Data is the driving force behind true healthcare transformation. By integrating lab values, we enable providers to measure care quality effortlessly. These data-driven insights empower physicians to act based on real-time information without adding to their workload. With patient-level insights at their fingertips, providers can execute the next steps in care more efficiently.
Our vision for the future of healthcare, especially in the lab space, is one where operational efficiency and care quality are not in conflict but work together to create a system that benefits everyone. We understand the frustration caused by prior authorizations, for providers, patients and the health plan, so we’re pioneering automated solutions that expedite the process. By leveraging innovation and automation, we reduce delays and ensure patients receive timely, high-quality care.
In today’s healthcare ecosystem, we are not just participants but leaders driving systemic change. Our commitment to simplifying the prior authorization process, supporting providers, and harnessing the power of data and automation is creating a future where healthcare providers are empowered, patient outcomes are elevated, and the system becomes more sustainable. The future of healthcare requires bold leadership, and we are proud to be at the forefront of that movement.
About the Authors
Julie Schulz, MD, MPH, is the VP of product at Avalon Healthcare Solutions. Dr Schulz is responsible for the product strategy and product go to market execution of Avalon’s Lab Insights solutions. She is a physician executive and product leader with experience building and leading health care decision support, analytics, and B2C products. Dr Schulz has a specific focus in value-based care, women's health, medical device & pharma, and patient & physician engagement.
Sarah Bretz, oversees genetic test management solutions. She has extensive experience in healthcare-related industries, including a decade in the lab industry focusing on population health and disease prevention solutions. Sarah also has experience in data analytics, where she advised pharmaceutical companies on market trends and digital asset utilization for new-to-market medications.
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