Aviva is working with Healthcode to transform outdated ways of working in the independent healthcare sector – starting with pre-authorisation
When insured patients need treatment, it typically falls to them to act as ‘go-between’, obtaining authorisation from their insurer and presenting the necessary information to the hospital. However, leading health insurer, Aviva, has found a better way, thanks to Healthcode’s pre-authorisation service.
The challenge
“The status quo was that the patient phoned our claims department and assuming they were eligible, we’d authorise treatment with a choice of hospital practitioners and give them a nine-character pre-authorisation code,” says Nigel Pearson, Aviva’s Supply Chain Transformation Manager. “What tended to happen was the patient would be asked for the pre-authorisation code at the hospital front desk, and either they didn’t have it with them or they had mis-heard it. This was far from ideal for patients who shouldn’t be the conduit for this information and it meant that the hospital would effectively take on liability if they provided treatment without pre-authorisation.”
Aviva recognised that it would be far more efficient, accurate and patient-friendly if it could send pre-authorisation details digitally to the hospital. Naturally, it turned to Healthcode whose online technology has long been used to automate time-consuming processes for the independent healthcare sector, from invoice clearing to membership verification.
Healthcode’s pre-authorisation service has now been implemented by Aviva with around 250 independent hospitals participating. This equates to around 50,000 pre-authorisations each month.
Nigel explains: “What now happens is that we push the pre-authorisation data through Healthcode’s secure online portal overnight. The hospital’s admin team can log onto their account and see all their new authorisations. For each authorisation, they can see the patient’s name, gender, date of birth, home address, contact phone, policy number, claim authorisation number, treatment authorised and the specialist or specialists.”
Hospitals can also use the channel to request changes to the scope of the authorisation. “For example, the patient is 93 years old and has some co-morbidities so perhaps they need to stay an extra night or the specialist cannot carry out planned keyhole surgery because it would be too risky for that patient. In those circumstances, we aren’t going to say no but the hospital needs to seek authorisation so the invoice matches what has been authorised,” adds Nigel.
The bigger picture
The adoption of pre-authorisation is a significant building block in Aviva’s strategy of making insured healthcare more efficient and straightforward and enhancing patients’ experience.
“Historically, private medical insurance has incrementally authorised each step in a patient’s pathway,” Nigel explains. “So, insurers might authorise them to have an initial consultation and maybe diagnostic tests but then they had to come back and obtain authorisation for the next step.”
Aviva’s solution is to negotiate Network Pathways with selected hospitals to provide complete packages of care and treatment for particular conditions. To date, three have been rolled out for cataract procedures, hip and knee replacements but more are planned over the next few years. The cataract network pathway includes optometry, the initial consultation and tests all the way through to the procedure, follow-up and checks.
“We send the pre-authorisation code for the network pathway through Healthcode and no one has to come back to us,” says Nigel. “With one-step authorisation, the Aviva member has the reassurance they are covered for the entire pathway which ensures a better patient journey. It reduces calls back to our claims team which saves time and money and reduces our billing admin as well.”
Aviva’s eventual aim is for every invoice to include a pre-authorisation number and Nigel points out that this will benefit providers too by reducing the number of bills held in suspense for manual checks. “It’s like a PO number in a normal business transaction,” he observes. “The pre-authorisation code means we can tie the invoice to the claim liability and settle the bill promptly in our automated batch run.”
Oiling the wheels
The adoption of Healthcode’s pre-authorisation service and the network pathways are part of Aviva’s ongoing digital strategy with the object of making its own business operations simpler and more efficient. But it isn’t just a matter of brand differentiation: Aviva’s objective is to automate more processes within the independent healthcare system so the cycle works more efficiently and patients have the optimum experience.
In the future, Nigel wants pre-authorisation data to be securely transferred and automatically pulled into the hospital’s workflow and admin systems via an API so when the patient arrives at the front desk there are no forms to complete and the patient has clarity about what treatment has been authorised.
He reflects: “It will take time but without Healthcode’s pre-authorisation service we would probably be nowhere near. Aviva have a close working relationship with Healthcode and are working with them on other initiatives, including the Private Practice Register. There is an alignment between Aviva and Healthcode because we both want to oil the wheels within our sector to increase efficiency, reduce costs and enhance the patient journey.”