Prior authorization

Date

Jan 16, 2025

Author

Rik Renard

Situation


In large healthcare organizations with multiple locations, nurses and clinicians often face roadblocks when making care decisions. For example, ordering a CT scan or prescribing a treatment often requires approval from the central HQ. This typically involved phone calls to HQ, where protocols lived in the heads of medical experts. Every call introduced delays, especially when HQ didn’t answer, or follow-ups were required. For patients, this back-and-forth often meant extended waits or even missed care opportunities.


Complication


The process was painfully inefficient. Nurses would assess patients, call HQ, and often get stuck in a bottleneck—either due to missed calls or vague guidelines that required more clarification. Each delay added frustration for clinicians, extended patient treatment times, and increased the workload on HQ teams. The more patients there were, the worse the problem became. The entire system was a house of cards, relying on human memory and manual communication.



Resolution


Our customers use Awell to codify decision-making protocols that were once stored in the minds of clinical experts. By implementing an intuitive, logic-based system, care teams automate these protocols into digital workflows. Now, when clinicians need to make a decision, they simply follow clear prompts. For example, if a CT scan is being considered, the system asks the right questions: “Have you checked X? Have you done Y?” Based on the answers, it instantly provides a recommendation like “Proceed with the CT scan” or “First, refer the patient to physical therapy.”

This approach has significantly reduced the burden on central teams, cutting down calls and eliminating delays. More importantly, it speeds up patient care while ensuring consistency in decision-making.

Care organizations use Awell to give clinicians the answers they need, exactly when they need them, delivering faster care and improving outcomes for everyone involved.

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With nearly 400 facilities, we need systems that can grow with the needs of the company and our many and varied clients. Awell scales with our requirements, enabling us to continuously provide data-driven quality improvements to our care teams.

Brittain Brantley

VP of Population Health, Wellpath

Healthcare is evolving rapidly and with Awell, our teams are enabled to navigate these complexities with agility, innovate swiftly, and maintain our leading position in value-based healthcare.

Brandon Sim

President and CEO, Astrana Health

With nearly 400 facilities, we need systems that can grow with the needs of the company and our many and varied clients. Awell scales with our requirements, enabling us to continuously provide data-driven quality improvements to our care teams.

Brittain Brantley

VP of Population Health, Wellpath

Healthcare is evolving rapidly and with Awell, our teams are enabled to navigate these complexities with agility, innovate swiftly, and maintain our leading position in value-based healthcare.

Brandon Sim

President and CEO, Astrana Health

With nearly 400 facilities, we need systems that can grow with the needs of the company and our many and varied clients. Awell scales with our requirements, enabling us to continuously provide data-driven quality improvements to our care teams.

Brittain Brantley

VP of Population Health, Wellpath

Healthcare is evolving rapidly and with Awell, our teams are enabled to navigate these complexities with agility, innovate swiftly, and maintain our leading position in value-based healthcare.

Brandon Sim

President and CEO, Astrana Health

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