Collaboration, Innovation and Reducing Provider Abrasion

We’re two ears, one mouth when listening to customer issues. We are fortunate to work with a variety of health plans ranging from large nationals to small regional plans.

Reducing provider abrasion is top of mind for all plans, particularly for the regional health plans that require cooperation with the providers in their communities to survive.

GuidingCare has made a lot of improvements in provider satisfaction for our regional plans. A big complaint from providers is the time it takes to receive an authorization from a payer. Our prior authorization portal helped solve this issue. With most of our plans using this technology, more than half of the authorizations get auto-approved without human intervention. Providers spend less time waiting for answers with the prior authorization portal; they quickly receive the information they need. 

One of our customers is a small regional plan in a state where national plans have a significant presence. Provider satisfaction is critical to ensure our customer can remain competitive. The regional plan came to us with ideas for how to improve the authorization portal. They wanted to bring together their organization, their local health system, and the GuidingCare team to create the best authorization portal in the industry.

As a technology vendor that values our customers, we knew it was an incredible opportunity to hear directly from the health plan and health system to find out what’s important to them then work together to see how our technology can meet their needs.

While this collaboration was not part of the scope of work or implementation plan, we were all in.

We spent three months with a tiger team and built an entirely new best-in-class product. We’ve sold six so far this year, and our customers are finding tremendous success.

For the customer who influenced this innovation, 80% of their authorizations come through the portal, and the majority are automatically approved. They have saved more than 5% of their overall care management budget.

These savings were made possible by listening to our customer’s feedback and innovative ideas, then working together to build them. Collaborating with our customers is a formula for success.

About the Author

Tom Joyer

Thomas Joyer, Chief Commercial Officer, Altruista Health (a HealthEdge Company)

Tom Joyer is the Chief Commercial Officer with Altruista Health and is responsible for developing strategic opportunities for new business development and growth for the organization. Additionally, he works closely with existing customers to increase the value they receive from Altruista’s products and services. He is a well-trained and highly successful sales leader with nearly 20 years of experience operating in large complex sales environments. Previously, he served for over a decade as Vice President of Sales with Health Integrated, a leading provider of care management services. In this role, he successfully contracted large, complex agreements with leading payers serving Medicaid, Medicare, Special Needs Populations; Commercial and Federal Employee Programs. Prior to Health Integrated, he served as Vice President and General Manager of Global Healthcare Exchange (GHX) Pharma Solutions Group where he was responsible for managing the Pharmaceutical Validation and Contract Management markets. Prior to being acquired by GHX, he served in sales roles with Neoforma, a supplier of healthcare supply chain solutions. Tom began his sales career with Southwestern Bell Corporation. He received a bachelor’s degree in Business from the University of South Florida.

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