AVIA Marketplace is the leading online resource for accurate, unbiased information about digital health companies and solutions. Our goal: To empower hospitals and health systems with the information they need to match with vendors who can meet their unique needs. We asked the top companies in the prior authorization space about their solutions and what they think the future of digital health looks like. No sponsored content or advertorials—just transparency and insights that decision-makers can use.
Arrive Health developed its care access platform to aggregate, normalize, and display real-time data from healthcare content providers in order to promote cost transparency, reduce administrative burdens, ensure patients receive the care they need, and inspire meaningful conversations about care costs and options. Care teams can use Arrive Health’s solutions to review eligibility and accurate pricing information at the point of care within the clinical workflow, with real-time notifications about coverage restrictions and automated prior authorization initiation; while patients receive targeted messages at key moments to drive better decisions and outcomes. Previously known as RxRevu, Arrive Health was originally founded to promote insurance coverage transparency and drive cost-effective prescribing.
In her role as Arrive Health’s Chief Operating Officer, Christie Callahan is responsible for operations and developing new solutions to reduce prescribing friction and increase access to care. Christie has worked in the pharmacy space for over a decade, focusing on interoperability, technology innovation, and process improvement. During her career, she has developed transformation strategies for a number of large healthcare companies, including specialty and mail order pharmacies, prior authorization departments, and call centers. Prior to joining Arrive Health, Christie served as Vice President of Strategy and Innovation for Members Services at CVS Health and as a consultant at Bain and Company.
Q: Can you tell us about your company and the challenges you are solving within the prior authorization space?
A: At Arrive Health, the patient-provider relationship is our true north. Our solutions leverage accurate, patient-specific data to help providers reach the best decisions with their patients. With real-time notifications for coverage restrictions and prior authorization details, as well as automatic initiation of the electronic prior authorization (ePA) process, providers can significantly reduce administrative burden and ensure transparent communication with patients and care teams. Our directly connected network combines real-time prescription benefit data (from payers and PBMs) with automated ePA capabilities to reduce provider burden, improve patient engagement, and speed time to therapy.
Q: How does your company differentiate from other vendors in the same category?
A: Arrive Health is more than simply a pipeline for ePA transactions. We have built a unique intelligence layer to confirm patient coverage, recommend covered medication options, and match question sets and responses whenever possible. This intelligence layer enables our three main patient and provider-centric goals:
- Keep patients on-formulary and avoid unnecessary prior authorizations whenever possible.
- Maximize automation and electronic channels to minimize manual data entry and speed time to resolution.
- Complete prior authorizations before the prescription hits the pharmacy to eliminate patient disruption and promote medication adherence.
By solving these problems, we eliminate thousands of faxes, phone calls, and duplicative work for providers and care teams, along with patient dissatisfaction from delays or denials.
Q: What are some of the biggest changes your company has seen around how health systems are approaching prior authorization, given the changes in the landscape over the past couple of years?
A: Health systems want a better solution to prior authorization, but in the past, manual and out-of-workflow ePA solutions have failed to deliver. As a result, this is an area where the appetite for experimentation is low. Further, key ePA players have been stagnant in optimizing the PA process for providers, care teams, and patients. Overall, they seek two requirements that many solutions fail to deliver:
- Complete network coverage, with one solution for every patient and medication.
- Immediate labor savings–automation justifies a change in approach.
Health systems are in the midst of a labor crisis and are hungry to improve the broken prior authorization process–with the right partner.
Q: What does an ideal client look like? How are health systems or health plans best organized for success in standing up prior authorization and adjacent capabilities?
A: Our ideal clients recognize the opportunity to drive change and are motivated to act. We’re looking for innovation partners that deeply understand the current state problems, and are ready for an ePA solution that serves providers. Our vision is an end-state that maximizes PA avoidance and automates data/question-set population, leaving only a simple review prior to submission.
Q: What measurable outcomes have you seen from your clients?
A: Today, our health system partners avoid prior authorizations nearly 32 percent of the time. Our integrated point-of-care tools alert providers about covered care options, which allows them to take meaningful action to avoid unnecessary PAs. These initial results led to partnerships with two nationally renowned health systems to partner in order to further transform ePA and develop an end-to-end solution, with initial launch planned in 2023.
Q: What major functional enhancements and/or product investments are you making in the near term to keep up with the evolution of automation generally?
A: Arrive Health’s core capability is building intelligent automation networks that bring together disparate data sources to improve patient access to care. As a result, we are constantly expanding our capabilities and investing in our approaches and architecture. We have already built networks between the nation’s largest payer/PBM databases and health system EHR workflows. Through these networks, we automatically deliver patient-specific cost, coverage, and medication alternative information. By adding in prior authorization functionality, we are expanding on the support we deliver to providers, care teams, and patients.
Q: How is your company partnering with clients as reimbursements and use cases shift?
A: We believe that to disrupt prior authorization, we must align ourselves with providers. Market solutions exist to serve payers and manufacturers, but direct service to providers is the way to drive true differentiation. Additionally, Arrive Health has taken on a number of investors, all of whom are health systems or their innovation arms (UCHealth, Providence, UnityPoint, Froedtert, UVA Health, and more). These partnerships further strengthen our focus and commitment to provider workflow improvement and products that support providers.
Q: What are the biggest opportunities health systems should be thinking about this year when it comes to automation?
A: Early in 2023, we acquired pharmacy automation technology from UPMC Enterprises to engage and support patients more holistically, while driving ongoing adherence. This technology can offload tasks from pharmacy teams so they can prioritize patient care.
Beyond that, the primary opportunity is prior authorization. Automation is more necessary than ever to relieve pressure created by labor shortages, and prior authorization is an area where many skilled resources are required for administrative activity. This is not an area to minimize or ignore for health systems as they chart plans for investment in automation tools. By automatically initiating the prior authorization process and proactively streamlining question sets and submission, we can reduce administrative burden and use automation to our advantage.
Q: How do you see the prior authorization space evolving in the next two to five years and beyond?
A: In the next two to five years, we will see real change in the prior authorization space. The combination of regulatory and market pressures are creating an environment where the status quo cannot persist. The key for health systems will be to identify partners that have the capabilities to drive transformational solutions and the organizational alignment to do so on behalf of providers.
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