MetroHealth Prior Authorization Automation Case Study

This case study details the challenges faced by MetroHealth, a prominent health system in Ohio, regarding prior authorizations. The organization dealt with manual workflows that burdened staff with time-consuming tasks, leading to delays in patient care and increased administrative costs. To address these issues, MetroHealth sought an automation solution, ultimately partnering with Experian Health. The automation process streamlined inquiry and submission tasks, significantly improving efficiency. The case study outlines how MetroHealth scaled its monthly authorization requests from 2,200 to 6,000, achieving a 173% increase. Additionally, it describes a 60% reduction in time spent on each authorization and a 50% decrease in follow-up time. The automation also allowed for proactive denial management, increasing lead time before scheduled procedures by 114%. The case study concludes with best practices for other health systems looking to replicate MetroHealth's success in automating prior authorization workflows.