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Emerging Health IT Leader Voluware Announces Growth Investment from Hughes & Company

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Investment will accelerate Voluware’s product innovation, support client success, and expand strategic partnerships as company speeds and simplifies prior authorizations

HUNTINGTON BEACH, Calif., April 17, 2023- Voluware, Inc., an award-winning provider of solutions to speed and simplify prior authorizations, announced today a capital investment from Hughes Company.  The private equity firm invests in growth and later stage healthcare software and technology-enabled service companies. The additional capital will accelerate the company’s product innovation and devote more resources to expanding payer coverage and geographic footprint, and client on boarding and support. With growing interest in Voluware from providers of revenue cycle management and electronic medical record solutions, the additional capital will also enable Voluware to acquire and support more partnerships and resellers for its prior authorization products.

 

Voluware was co-founded by Steve Kim, MD, who as a practicing pediatric urologic surgeon with Children’s Hospital Los Angeles became deeply concerned with the impact of prior authorization delays, denials, and complexity on patients, providers, and staff. Dr. Kim witnessed clinical risks to patients, financial risks to healthcare organizations, and turnover risks to staff. Without seeing a solution in the market to effectively address these issues, Dr. Kim invested years working with hospital and ambulatory practice professionals to research and develop a truly effective solution.

 

Dr. Kim and his co-founder, Marty Staszak, launched Voluware with a mission to ensure patients receive the care they need without unnecessary delays created by today’s manual administrative workflows and ineffective solutions. Voluware’s VALERⓇ solution provides health systems, hospitals, clinics, and payers with a cloud-based platform to automate prior authorizations. Voluware’s workflow-centric, customized approach to each client’s unique needs accelerates time to results and reduces barriers to access. Its single, custom-tailored interface centralizes, standardizes, and automates fragmented prior authorization workflows across all payers and all service lines. Voluware’s VALER solution was recently recognized with AVIA Connect®’s Top Company for Prior Authorizations.

 

Dr. Kim, who is Voluware’s CEO, said about Hughes & Company’s investment, “We’re thrilled with the commitment that Hughes & Company has shown to our mission of finally addressing the clinical, financial, and operational risks of prior authorization processes and products that exist today. As healthcare technology experts, they understand the patient, provider, and staff risks as much as we do. We also look forward to their valuable strategic guidance in helping us to acquire and support clients better than ever before. The entire Voluware team prides itself on partnering with our clients to help drive efficiency and real results.”

 

Jim Denny, Managing Partner at Hughes & Company, added, “Voluware is a diamond in the rough. Solving the prior authorization nightmare on an all-payer basis is a huge problem. There are plenty of companies that can do a piece of it, but nobody has figured out how to do all of it. The Voluware team has walked in their clients’ shoes and developed solutions that will finally benefit patients, providers, and healthcare staff. We look forward to partnering with the Voluware team to address a longstanding need to simplify prior authorizations.” 

 

With Hughes & Company’s investment, Mr. Denny will join Voluware’s Board of Directors. Denny brings to Voluware deep healthcare technology expertise. Before becoming an health IT investor in 2018, Mr. Denny was co-founder and CEO of Navicure, a provider of revenue cycle management solutions. He led the company from 2001 to 2017 through its merger with a competitor to become what is now Waystar. 

 

About Voluware 

 

Voluware provides health systems, hospitals, and clinics powerful custom workflow automation solutions for today’s manual prior authorizations and referrals. Voluware’s proven VALER® platform addresses the clinical, financial, and operational risks of complex prior authorization processes, creating improved patient outcomes, financial performance, and staff morale and retention. VALER is one platform to streamline, automate, and continuously optimize prior authorization workflows. Follow us on LinkedIn and Twitter. 

 

Contact Steve Kim, CEO & Co-Founder

626-344-2005

steve.kim.md@voluware.com

 

About Hughes & Company

 

Hughes & Company is a private equity firm investing in growth and later stage healthcare software and technology-enabled service companies. The Firm is an active investor and works closely with its portfolio companies on initiatives to accelerate growth, enhance customer value propositions and increase long-term retention by applying institutional best practices and disciplined execution. The Firm maintains an extensive network of longstanding relationships with senior executives, advisors and partners across the healthcare software and technology-enabled service market who assist Hughes & Company and its portfolio companies in a range of capacities.

 

To learn more about Voluware and its VALER™ product, visit voluware.com

AVIA Connects’ Q&A: Just Transparency and Insights that Decision Makers Can Use

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AVIA Marketplace is the leading online resource for accurate, unbiased information about digital health companies and solutions. Their goal: To empower hospitals and health systems with the information they need to match with vendors who can meet their unique needs. They 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. 

Q: Can you tell us about your company and the challenges you are solving within the prior authorization space?

A: Voluware was founded with a mission to ensure patients receive the care they need without unnecessary delays created by today’s manual administrative workflows. Our cloud-based platform, called VALER®, standardizes, streamlines and automates prior authorizations for health systems, hospitals, ambulatory clinics, and payers. Voluware’s workflow-centric and customized approach to each client’s unique prior authorization needs accelerates time to results and reduces barriers to access.

Q: How does your company differentiate from other vendors in the same category?

A: Voluware differentiates itself from other vendors in the prior authorization space with our understanding of both the deep technical complexities and the practical workflow realities that clients face in order to function in today’s evolving prior authorization environment. Our VALER platform was built from the ground up with not only the end user in mind, but also with the understanding that each authorization represents a patient waiting for care.

VALER is the only solution in the market that robustly automates prior authorization submissions across all payers and service lines. While most other vendors primarily offer only authorization status verification across a few select payers for a few select services, VALER provides one source to comprehensively submit and verify authorizations across over 75 payer web portals with more than 1,000 payer fax forms.

Our platform is not a one-size-fits-no-one approach to prior authorizations. We understand that each client brings its own unique mix of complex payer-specific requirements, inherent EHR limitations, and myriad workflows that aren’t necessarily compatible with a single approach. VALER tailored to each client’s broad organizational workflow needs in order to maximize workflow automation and eliminate manual and duplicative data entry wherever possible.

VALER also rapidly adapts to changes in payer rules or requirements–a frequent occurrence, as anyone who has dealt with prior authorizations understands. In addition to the ability to centralize and maintain fragmented payer authorization workflows, VALER can quickly update and incorporate payer workflow changes at runtime, with no long waits for software upgrades or support tickets.

Lastly, our clients enjoy unparalleled real-time visibility around prior authorizations. Over 80 percent of prior authorization workflows are completed manually, which means that it is virtually impossible to clearly grasp the root causes of bottlenecks and costly errors. But because prior authorizations are submitted and verified in VALER across all payers and service lines, clients have a clear view of every aspect of the prior authorization life cycle, from provider order to closed out prior authorization back in the EHR. We also provide real-time data and custom reporting on staff productivity, payer turnaround times and payer responses, along with detailed audit trails and activity logs.

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: With over a decade of experience building prior authorization workflow automation solutions for patient access teams, the most significant changes that we’ve seen in how health systems are working to address prior authorizations have been the increased adoption of robotic processing automation (RPA) and labor offshoring/outsourcing. Each approach has its merits, but there are also significant issues that limit efficiency and effectiveness.

With RPA/low code options for building automations, client teams can configure automations for highly standardized and repetitive tasks with good results. But the nature of prior authorizations is non-standardized, complex, and constantly changing, which is where problems arise. Configuring and maintaining these automations requires time, effort, and financial investment, and the complexity of these tasks can quickly consume client teams and negate any efficiency gains.

With respect to outsourcing/offshoring as labor arbitrage, organizations can have difficulties understanding local payer rules, idiosyncrasies, and nuances when dealing with specific payer prior authorizations. That disconnect between providers and offshore patient access staff can inadvertently add delays and frustration to prior authorization workflows and erode or undermine the cost savings associated with labor arbitrage.

VALER bypasses these issues and empowers existing patient access teams to do more. We eliminate unnecessary manual tasks and data entry and leverage staff experience, relationships, and knowledge.

Q: What does an ideal client look like? How are health systems best organized for success in standing up prior authorization and adjacent capabilities?

A: The ideal VALER client doesn’t necessarily fit with a specific structural mold. Our most successful clients are organizations that follow a few general principles in their preparation and approach to implementation:

  1. Understand what current prior authorization workflows look like across the organization. Prior authorization workflows are incredibly fragmented and highly variable in nature. We frequently find significant variation in how prior authorizations are processed, not only from team to team, but also between individual staff members. This often reflects a lack of standardization, transparency, and education when it comes to payer-specific authorization requirements. Organizations should identify best practices and move to standardization. Ideally they take the time to develop process maps and create clear roles and responsibilities, which can decrease friction and build accountability.

2. Understand the time, effort, and cost involved with prior authorizations in order to prioritize efforts. Identifying overall costs for managing prior authorizations across various service areas can help organizations gain a clear understanding of where to start and how to maximize ROI and minimize time to value. While measuring this burden, organizations should consider the operational staff time and costs that the prior authorization process incurs and the denied dollars attributable to prior authorization errors.


3. Create a clear roadmap for transforming prior authorizations. Working to define a clear roadmap for implementation has been a hallmark for success with VALER clients. Frequently, we would start VALER with centralized patient access teams with a high volume of prior authorization submissions and verifications–we typically see this in health systems with a centralized team that handles high volume diagnostic imaging and/or surgery/procedure authorizations. In our experience, looking at areas of high impact first and establishing early wins with automation leads to increased engagement and user adoption across other teams.


4. Do your homework–listen to your staff to get their input and buy-in. Listening closely to key staff members who actually work on securing prior authorizations is critical to successful implementation. We’ve seen many prior authorization solutions that apply new technology (AI, machine learning, or RPA) to the problem with no meaningful understanding of the practical workflow implications involved. Organizations that take the time to vet solutions and invite the feedback of frontline staff are much better positioned to understand the opportunities and limitations of technology. Involving user input better aligns expectations and fosters engagement that can better drive meaningful adoption and results.


Our most successful clients are the ones that thoughtfully approach problems, identify opportunities, and develop clear plans with VALER. The Voluware team can also lend its expertise to assist organizations with successful planning and implementation.

Q: What measurable outcomes have you seen from your clients?

A: VALER clients have seen many benefits related to their prior authorization workflows. The team at Oregon Health & Sciences University (OHSU) reported the following results with VALER for their central patient access team’s prior authorization workflows:

  • Staff spent 45 percent less time processing prior authorizations (including submission, verification, and pushing back to the EHR)
  • Overall authorization volume increased 11 percent with the same or smaller staff
  • Authorization days out metric increased from 5 to 13 days, with fewer cancellations and reschedules

Other VALER clients have similarly experienced a 40-50 percent reduction in overall prior authorization staff processing times, doubling of staff productivity, and higher satisfaction with prior authorization workflows.

With respect to denials related to prior authorizations, an academic medical center client reported a reduction in first pass denial rates of more than 50 percent within the first year of utilizing VALER.

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: VALER has developed and is currently implementing a pilot with a major national health plan for application programming interfaces (APIs) to provide the following real-time prior authorization functionalities:

  • Pre-check to determine PA requirements for medical, radiological, DME, Part B drugs and home health care services
  • Electronic submission of PA requests directly to payer
  • Auto-approve requests when available from payer
  • Electronic notification and information about authorization adjudication
  • Eligibility verification
  • Referral status checking (if required for authorization)

Q: How is your company partnering with clients as reimbursements and use cases shift?

A: At Voluware, we pride ourselves on being good partners with our provider client teams that work on the frontlines. Our VALER platform has always been custom designed with client team workflows in mind, with runtime-changeable architecture that continuously adapts and evolves to meet new use cases with respect to payer authorization requirements and workflow changes. In this way, we provide clients with a flexible system to keep pace with an ever-changing reimbursement environment.

Q: What are the biggest opportunities health systems should be thinking about this year when it comes to automation?

A: Health systems are facing staffing shortages in the administrative ranks as a result of the pandemic and the subsequent “Great Resignation,” which means that health systems need to focus on targeted automation opportunities with the highest return on investment. Prior authorization submission and verification workflows are a high-value opportunity for workflow automation with significant operational impact for depleted patient access teams, with the added benefit of fewer costly downstream denials and avoidable write-offs. When health systems invest in the right technology platforms to support automated prior authorizations, they can empower staff to improve productivity, address key bottlenecks to patient access, and mitigate lost revenue.

Q: How do you see the prior authorization space evolving in the next two to five years and beyond?

A: Healthcare organizations will continue to advocate for CMS regulations that require payers to transition from antiquated workflows to electronic prior authorizations with more automation. We can already see this momentum with proposed CMS rule changes regarding prior authorization and federal and state legislative efforts to improve standardization, transparency, and accountability. Greater regulatory scrutiny will target not only health plans, but certified EHRs as well in order to promote interoperability and facilitate electronic exchange and adjudication between payers with application programming interfaces (APIs). Compliance will take time and significant labor and investment for both payers and providers to achieve real-time request and adjudication of prior authorizations.

Today, VALER provides a bootstrapped authorization clearinghouse that already allows for electronic exchange and meaningful automation of existing manual workflows. Meanwhile, we’re hard at work building a roadmap for the future of real-time APIs for all prior authorizations across all payers.

Steve Kim, MD.

Steve Kim, MD.

Co-Founder, President and CMSO

Using Technology to Solve the Most Expensive Problem in Healthcare: Change Management

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From Pitchforks to Life Rafts

Having sat in enough sales meetings and heard over and over that IT support and IT resource availability was making it impossible for administrative staff to get access to technology platforms like VALER to solve labor cost and labor shortage issues, while my initial reaction was around something that involved pitchforks, I eventually settled in around an idea that involved life rafts.

 

The life raft we created is a true technology partnership, a new hybrid business model including cutting edge intelligent technology with automation workforce, and the rapid change management processes to go with it.
 
Born out of a deep understanding of the manual Prior Authorization problem – VALER is actually a service, truly, Software-as-a-Service, or perhaps, Software-on-Demand-as- a- Service.

 

VALER solves the hardest problem in healthcare: delivering a positive ROI to providers around the manual labor associated with prior authorizations. We do it with brute force, by automating every single transaction in a single platform, in whatever form the transaction takes.

 

Extreme execution velocity is what provides buoyancy to the life rafts because execution velocity dramatically reduces change management costs. VALER deployments are fast, and support costs are so low that Voluware can offer continuous change management, on demand, in near real time, over the lifetime of a VALER deployment.

 

VALER as a true technology partnership, offers a new hybrid business model that includes both cutting edge automation technology and the technology workforce and rapid change management processes to go with it.
 
At Voluware, we combine ephemeral programming™ and hyper iteration™ to create VALER platforms that solve the most expensive problem in healthcare: change management.


“The VALER deployment was the most successful IT project
we’ve ever done.”
 
“The Voluware team is the best vendor we’ve ever worked with.”
 
“I wish all vendors were like Voluware.”


To learn more about how VALER could improve staff retention as well as clinician satisfaction, get in touch with the VALER team
today.

VALER makes AVIA Connect’s Top Prior Authorization Companies Report

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Best in: Prior Authorization

Voluware Named to AVIA Connect's Top Prior Authorization Companies

News Provided by 
Voluware, Inc 
Dec. 21, 2022, 9:07 ET

HUNTINGTON BEACH, Calif., Dec. 21, 2022 /PRNewswire/ — Voluware, Inc. announced today it was recognized as a Top Company in Prior Authorization upon conclusion of extensive research and company outreach by AVIA Connect, the leading digital health marketplace.

Voluware was founded with a mission to ensure patients receive the care they need without unnecessary delays created by today’s manual administrative workflows. Voluware provides health systems, hospitals, clinics, and payers a cloud-based platform, VALER®, to streamline, manage, and automate prior authorizations. Voluware’s workflow-centric, customized approach to each client’s unique needs accelerates time to results and reduces barriers to access.

“We’re honored to be recognized by AVIA Connect as a top Prior Authorization vendor,” said Steve Kim, MD co-founder and CEO of Voluware. “The pandemic and staff burnout has increased the need for innovative technology like VALER that delivers real results. We take pride in working closely with clients to help take back control of prior authorizations for better patient care.”

The Top Prior Authorization Companies Report represents analysis of health system implementation data across the country and highlights broader industry trends. Given the complexity of prior authorization, the report helps define the prior authorization landscape and how these solutions best support patient care.

“The Top Companies report provides health systems with insights and clarity into the complex prior authorization space and how that fits into larger revenue cycle challenges.” said Dhiraj Patkar, SVP of Digital Health Solutions at AVIA. “We are thrilled to help health systems understand and identify solutions that can enable providers to obtain approval from payers before delivering care, in order to prevent lost revenue and reduce expenses.”

Access the full report findings from AVIA Connect’s Top Prior Authorization Companies list here.

About Voluware

Voluware provides health systems, hospitals, and clinics powerful custom workflow automation solutions for today’s manual prior authorizations and referrals. Voluware’s proven VALER® platform delivers staff efficiency and avoids costly denials by providing one place to streamline, automate, and continuously optimize administrative workflows. Follow us on LinkedIn, Facebook, Twitter.

Contact Steve Kim, CEO & Co-Founder
626-344-2005
steve.kim.md@voluware.com

About AVIA

AVIA is the nation’s leading digital transformation partner for healthcare organizations. AVIA provides unique market intelligence, proven collaborative tools, and results-based consulting to help solve healthcare’s biggest strategic challenges. Learn more about AVIA and AVIA Connect, the industry’s premier marketplace for digital health innovation, at aviahealthinnovation.com. Follow us on LinkedIn and Twitter.

AVIA Press Contact
Sean Chase
schase@ariamarketing.com
(603) 307-9428

SOURCE Voluware, Inc

How Do I Calculate My Organization’s Prior Authorizations Burden?

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Need Help Calculating Your Organizations Prior Authorization Burden, Get our downloadable spreadsheet.

“How big is your organization’s prior authorization problem?”  More often than not, when I ask this of patient access teams at medical practices, hospitals, and health systems, there is a long pause followed by a “we don’t know.”   If you find yourself in this position, you are not alone.  A few organizations have been able to properly quantify their prior authorization problem because the workflows are so fragmented, manual, and siloed across multiple functional areas.  We’ve spent a decade carefully listening, distilling, and characterizing all the various prior authorization workflows across organizations and want to share some thoughts on how to quantify not only the extent of the problem, but also how to focus on where to start.   As a former academic healthcare outcomes researcher, – Peter Drucker says,  “you can’t manage what you don’t measure.“

 

Who’s doing what part of the prior authorization? Part of the difficulty in quantifying the burden of prior authorizations lies in the hyper-fragmented and highly dispersed nature of the workflows themselves.  At some organizations, the initiation or submission of prior authorizations is done in the ambulatory clinics, but verifications for the facility are done by a central authorization team.   With others it is highly centralized across the organization by a large central team.  Additional challenges arise when the initial submissions is dependent on independent community provider offices that refer in cases who are frequently on different EMRs that don’t talk to each other.  Much of these workflows are dependent on faxes, emails, and phone calls.

 

How do you begin to estimate something that is so manual?  So many organizations struggle with how to quantify exactly how much time is spent on prior authorizations by their staff.  Because over 80% of the today’s prior authorization workflows require manual processing (fax forms, phone calls, typing into web portals), it can be a challenge to come up with a number. 

Over the years, we have spent a considerable amount of time working with patient access teams to estimate the amount of staff time that various prior authorization workflows take, and we typically recommend this as a good way to begin formulating some initial estimates. Here are some of the basic inputs that we find useful in helping to quantify current staffing requirements:

  1. Estimated volumes of monthly/annual prior authorization transactions (can further be broken down into specific service types or service areas depending on your organizational needs)

o   Diagnostic Imaging

o   Surgeries/procedures

o   Chemo/Infusion therapy

o   Medications

o   Notice of Admissions

o   PT/OT

o   DMEs

 

  1. Estimated average time spent on processing particular prior authorizations by workflow type (fax forms, clinical survey-based web portals, standard web portals, etc).  Estimates of processing times should be inclusive of the following: gathering info from EHR, identifying requirements, submitting prior authorizations, checking on status to verify prior authorizations, and inputting of data back into EHRs. 

Although estimated times can vary by organization, by authorization modality (fax, web portal), by payer, and by individual staff member, our experience has been that the average staff processing time per authorization is generally between 16-25 minutes.  According to the most recent CAQH Index report, the average time for prior authorizations is 20 minutes.

  1. What is the number of current staff working on processing prior authorizations?   This can be somewhat tricky to  come up with headcount depending on whether staff spend a majority of their daily time working primarily on prior authorizations or in conjunction with other front-end activities (eligibility verification, scheduling, etc.).  For some organizations, it can be relatively straightforward with a central authorization team, and for others distributed across various clinics.  

 

With these basic estimates in place, you can begin to understand what your organization’s overall staffing requirement needed to process current prior authorization volumes.   It’s also a good way to understand if your teams are indeed understaffed (particularly with worsening staffing shortages) to reasonably handle increasing volumes.  With this data, we can begin to estimate not only the average authorizations/FTE/day, average annual authorizations/FTE, and ultimately what total organizational staffing costs look like.

 

An additional methodology for quantifying the burden of prior authorizations beyond staff time calculations is denied claims payments related to prior authorization errors/issues.  Metrics such as first pass authorization denial rates can be useful to identify the scope of the financial impact that can be quite significant and variable depending on your organization’s revenue cycle processes and performance.  Much of the denials attributable to prior authorizations may be avoidable errors and write-offs due to front-end activities (e.g. putting in correct authorization tracking numbers into claims).   

 

If your organization has access to 835/837 via your clearinghouse provider, you can get an estimate of not only the total volumes (what volume of claims had the prior authorization number populated on 837s), as well as what the volume of prior authorization denials are on 835s, and total denied dollar impact.   Depending on the service lines and the performance of your revenue cycle teams this can add up to a significant financial burden above and beyond your staff’s time processing authorization on the front-end. 

 
Let us help you calculate your organization’s prior authorization burden with this FREE downloadable spreadsheet.

Download the Spreadsheet

3 Key Components to Improve Prior Authorization Workflows

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Looking to Improve Prior Authorization Workflows?

There are 3 basic things to consider when striving to improve prior authorization workflows; The What, The How, and the The Who. Let’s first talk about the what.

 

The What-

The first thing to consider when setting out to improve your prior authorization workflows is understanding the what of the submissions. One of the first steps to help you begin to understand the workflow is to get a handle on what services require prior authorizations for which payers. I know that this can be incredibly daunting, but those organizations that at least begin to create internal rules, often done in a spreadsheet, can have a place to begin to work with. By getting your leads and your staff on various access teams, this can help identify problem areas and define rules to help both existing and newly onboarded staff have an idea of what services require authorizations. We know that this can be a bit of a nightmare since payers are always changing the rules, but you have to start somewhere and build “tribal knowledge” that can be shared and updated.

 

The How-

Knowing how your payers want to receive authorizations, whether it is fax forms, a phone call or a specific web portal for the submission is crucial in having a more efficient prior authorization submission workflow. There are a variety of methods that people have figured out over time that work for them, but all too often we have staff resorting to faxes and phone calls even though there is a potentially faster submission and approval process via a web portal.

 

The Who- 

Given that 80% of prior authorization submissions and verifications are manual, we see a substantial amount of delays and errors that occur. More importantly, where there are different teams that are responsible for different workflows, for example authorization initiation / submission vs verification, there can be lack of clear delineation of roles and responsibilities and poor accountability. This often leads to gaps in hand offs which further delays approvals and care. For complex organizations especially, we recommend having collaborative discussions between teams to define roles and expectations and be sure that they are working together. Of course, having a centralized platform like VALER that provides real-time visibility can help tremendously.

Steve Kim, MD

Steve Kim, MD

CEO & Co-Founder Voluware, Inc.

5 Components of Effective Prior Authorization Implementation

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Automated submissions of prior authorizations and referrals is more achievable than you might think.

In today’s environment, the future for prior authorization automation is critical, and has become essential for healthcare systems to deliver timely care to patients. Automated submissions are changing healthcare with insights that help identify missing required patient information, clinical data, and payer turn-around times. Key decision makers are able to proficiently stay on the cutting edge by collaborating and creating revolutionary modules. Want to get caught up and hear how implementing VALER will help you to see big gains and results? Success starts with a clear definition and understanding the accompanying workflow processes.

1. Vision

     The first step is the vision of the organization’s leaders and stakeholders. Outlining the objectives of what’s possible, how to make it happen, and how to understand all the details of current processes. Success starts with a clear definition and understanding the accompanying workflow processes and tailoring VALER to support patient care, and a more satisfying work experience for clinicians and staff. What is needed to create, implement, and sustain your instance ofVALER – workflow; And the reason workflows are so important is that it drives the build to deliver efficiencies as well as accurate and reliable insights.

2. Workflow

      Workflow determines everything from integration to every aspect of VALER that is deployed. This is why the number one component needed for successful implementation is understanding the workflows. Configuring and tailoring VALER to ensure the solution supports effective clinical processes and complements efficient workflows requires input from SMEs, Superusers, and the employees they report to to be intimately involved in every detail of shaping VALER. Together we observe everything that happens before and after where VALER is going to be slotted in. We do detailed observations of the customization features in VALER: authorization fax forms, authorization portals, NOAs, eligibility, referrals, as well as whatever is contracted. In summation, we take the hive mind knowledge that exists in scattered papers, PA “bibles” and user’s brains and put as much in the design and build as possible. When staff feel included in the development process, the adoption is faster and optimized. Identifying insurance portals that yield the highest value to build-out technology and take advantage of the automation submission time-saving features will help recognize ROI during pre-launch.

3. Portal Integrations

     To boost productivity and improve outcomes with technology we do a deep dive into the vagaries and different paths the portal authorization submissions take and integrate that into your instance of VALER.  Because we know it can be a struggle to keep up with the changes to insurance portals, our software is specifically designed to help you accomplish connectivity reliably and efficiently. That’s what VALER is all about—maximizing productivity of each user while staying apprised of changes to portals. Our technology is not confined to incremental change and it is why fine-tuning and constant feedback is on-going throughout the design phase and entire implementation.

4. Interior Design Phase

     This phase is what we refer to as the first version of their instance of VALER, and as they start providing more and more input into what to name specific fields, which order they want to see these fields, what they want in their VALER grid view, and even what colors they want certain things to be. The goal is to make VALER as intuitive as possible for each client. While workflow tentpoles are the same across the board, the details in the workflow are all as different and unique as each department and each organization. We have yet to see two workflows look the same even within the same facility.

5. Continuous Iteration

     One way to drive trust in automated submissions is by giving end users the ability to be intimately involved in the refinement and to provide consistent feedback. First, this allows them to see more into the inner workings of VALER, which helps with the adoption. Second, it will inevitably improves and tailors the tool to their processes. Third, when users feel included in the development process, the better their experience and partnership for creating new modules in VALER.  In a recent interview titled “OHSU – When great isn’t good enough” two leaders in this space share their excitement on the key components needed for an effective implementation and ongoing collaboration.

 

Learn More – – If you would like to hear more about VALER we encourage you to check out what our partners are saying. Automated submissions of prior authorizations and referrals may seem like a tall task to implement, simply stated with the right vision and direction—it’s more achievable than you might think.

2022 NAHAM’s Prior Authorization Roundtable Recap

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Hear insights from our CEO

I had the honor of being asked to participate at NAHAM’s Prior Authorization Roundtable in October 2022 bringing together stakeholders from provider, payer, and vendor communities in an effort to stimulate discussions around potential solutions.  

 

Having spent time as a front-line provider requesting prior authorizations for my patients, a value-based healthcare researcher developing and implementing evidence-based pediatric surgical care pathways, and now as an entrepreneur looking to build technology infrastructure to automate prior authorizations, I found this discussion interesting from an unique vantage point of understanding all 3 sides. 

 

Several key points that were highlighted:

·        Payers are frequently constrained by either CMS defined coverage guidelines (NCDs – national coverage determinations, LCDs – local coverage determinations) and/or by contractual decisions made by employers in their sponsored plan choices.

·        Despite a desire to have standardized clinical guidelines across all payers, plans and their medical directors consider this as an area of competitive differentiation and/or a grey area where medical judgment is applied to the best of their abilities and within compliance with NCQA and URAC requirements.  

·        There is frustration on the part of payers on what is considered unnecessary care requests that are not justified by evidence-based guidelines and literature.   

·        For providers, each payer has its set of opaque prior authorization/pre-certification rules for different service lines, which all seem to be continuously changing.  Maintaining and managing all the different, shifting payer rules seems to be a Sisyphean task, one certainly not capable of being supported by today’s EHRs and practice management systems.

·        There is a need for a national clearinghouse for prior authorization transactions.  One that can seamlessly integrate into EHRs/PMS and act as a single interface for all payer prior authorization transactions.  Most agreed that the existing x12 278 standard does not adequately cover all the data elements necessary in a prior authorization transaction.  This is why there is little to no adoption outside of a limited set of notice of admissions workflows today.

 

There were several ideas that I took away from the conversation that I feel merit additional discussion:

·        Transparency on authorization requirements – a standard, machine-readable format from all payers to provide their established guidelines around specific sets of services.  This would include info on ICD-10, CPT/HCPCS/RxNorm, as well as any delegated benefit manager (eg AIM, NIA, eviCore, etc) and specific product information.  This would allow for providers to develop and maintain rules that can help better guide prior authorization requests and eliminate unnecessary errors/work.

·        List of which services do NOT require authorizations (“no auth required”) –  this would save a tremendous amount of time, cost, frustration, and delay for patients waiting for care.  This is an area payers can easily agree to as there is substantial cost generated from unnecessarily submitted prior authorizations, which still require review for compliance reasons.

·        “Open enrollment” period for payer authorization rule changes – create specified windows/periods of time during the year when payers can make changes to prior authorization rules.   This would help address the highly variable rule changes that frequently do not get recognized by provider teams.

·        A national clearinghouse for prior authorization data exchange.  This is the holy grail and what Voluware has been methodically building with our VALER all-payer, all service line payer network.  One place to 1) seamlessly integrate with EHRs/PMs, 2) comprehensively cover across legacy fax forms and web portals, 3) rapidly update and maintain changing payer rules.  

 

Certainly, we all hope that NAHAM and other organizations can keep the momentum going when it comes to offering practical, workflow-driven solutions to prior authorizations.  I hope that the spirit of collaboration and interest in real-world validation of innovative solutions continues.

Steve Kim, MD

Steve Kim, MD

CEO & Co-Founder Voluware, Inc.

Why Are Prior Authorizations So Manual?

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So why are prior authorizations such a manual process?  Whether it’s the joy of filling out paper fax forms, the carpal-tunnel inducing manual entry of data into payer web portals, or being on endless hold on the phone, prior authorizations today remain the bane of most practices:
  • The American Medical Association estimated that $31 billion is spent annually on prior authorizations by providers.
  • The Kaiser Family Foundation estimated 868.4 million hours are spent annually obtaining prior authorizations.
  • According to Milliman, manual prior authorizations cost $10.78 per transaction vs. $2.07 for an electronic transaction.  That’s $8.71 in savings per electronic transaction.
So one would think that in this day and age, that prior authorization transactions should be as easy as paying bills on your smartphone.  Guess again.  So why are prior authorizations still stuck in the  world of 1980’s fax tones?
 
1) Like politics, all healthcare is local.  Each geography has its own unique mix of providers, payers, and plans.  What that means, is that it is impossible to have any semblance of standardized workflows.  Each payer has its own fax form or clunky home-grown web portal that maps to its own internal workflows.
 
2) Local business requirements are always changing.  There are constantly changing forms or payer web portals.  Keeping up with change in today’s EHRs or practice management systems is impossible.  (How fast does your EHR vendor make changes? months? years? at all?)  Remember, these systems were never designed to manage change at the pace of the real world.
 
3) Everyone has their own system. None talk to each other today.   Whether it’s siloed provider EHRs or ancient payer systems, none meaningfully transacts electronic data with all their business partners.   It’s hard enough to get Cerner systems to talk to each other, let alone with say an Epic, Allscripts, or NextGen EHR.  And don’t even think about interoperating with a DOS payer system.
 
So, all healthcare is local, local business requirements are constantly changing, and none of our systems talk to each other.  What you get is $31 billion of last mile work-arounds to get anything done. We pay people to transcribe data on paper fax and type data into outdated systems.
 
This. Is. Insane.  As a physician working in the trenches, this is appalling and offensive.
 
This is why we have spent years studying the prior authorization problem. This is why VALER delivers automation today for prior authorizations, referrals, and eligibility.
 
To learn more, shoot me an email or message me: www.voluware.com steve@voluware.com @steveskim @voluware

Customer Love

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Customer love is a key metric for our company. All that (somewhat cheesy) stuff about loving your customers, who love you back, thereby creating a virtuous cycle: it’s true. It’s also one of things that powers Voluware. We passionately assert that we aren’t just software; we are truly software as a service.

 

So here’s what we do to feed the virtuous cycle of customer-Voluware love. It basically boils down to 2 main principles: (1) capitalize on VALER’s unique qualities and (2) cultivate customer communication.

 

  • Everyone in the company is on the customer support emails: from the CEO to sales and marketing to every last engineer. Because we customize our software to each client, it’s critical that we try to understand what it’s like to be in the user’s shoes.
  • A corollary of the above: no robotic email reply or ticketing system. We will put off a ticketing system for as long as we can because we want each user to feel the personal touch. This isn’t just benevolence on our part. It’s how we have a finger on the pulse of the customer and learn about new pain points that VALER can solve.
  • We insist on feedback. We tell our customers over and over again, “We can’t get you to where you want to be unless you talk to us.” We insist on it because, over 90% of the time, we can innovate or problem-solve right away. We don’t have to wait for a software release in a few months. We don’t have to put it into a queue. We can execute while the users are on the system. That’s the beauty of liveware – what we call a run-time changeable system. (For more on liveware, see our CEO’s blogpost from July 2018 on it). It’s ridiculously powerful and I can’t imagine doing it any other way.
  • Customizing VALER. The process of customizing VALER means we learn the workflows intimately. From kickoff to implementation and well into deploy, we have to maintain great communication or else the constant iteration to arrive at the ideal VALER won’t happen.

 

Recently, one of our customers was asked by another healthcare vendor to rate the implementation process in comparison to other software implementations. Our customer told another vendor and happened to tell me later as an afterthought: “We’ve never felt more supported with any other place company or vendor than the VALER team. VALER is all in and all they want is to for us to be as successful as we can while using their software.” I could not have asked for a better testimonial of customer love.

Privacy Policy

Last updated: 10/12/2022

Please read this Privacy Policy (the “Privacy Policy”, “Policy”) carefully before using the Voluware.com website (the “Service”) operated by Voluware, Inc. (“us”, “we”, “our”, or the “Company”).

This page informs you of our policies regarding the collection, use and disclosure of Personal Information (as defined below) when you use our Service. We will not use or share your information with anyone except as described in this Privacy Policy.

We use your Personal Information for providing and improving the Service. By using the Service, you agree to the collection and use ofbinformation in accordance with this policy. Unless otherwise defined in this Privacy Policy, terms used in this Privacy Policy have the same meanings as in our Terms and Conditions, accessible at www.Voluware.com.

 

Information We Collect

When you open an account , we may ask you to provide us with certain ‘Personal Information’ that can be used to contact or identify you, verify your identity, address or other information or to manage risk and compliance throughout our relationship. We collect this information for the purpose of providing the Service, identifying and communicating with you, responding to your requests/inquiries, servicing your purchase orders and improving our services. ‘Personal Information’ means data that identifies you and is associated with a specific person. ‘Personal Information’ does not include information that is anonymous, aggregated, or is no longer identifiable to a specific person.

● Account Information – text-enabled cellular/wireless telephone number, machine or mobile device ID, Facebook ID, Facebook Messenger ID, and other similar information.

● Personal Identification Information (“Personal Information”) – your name, date of birth, email address, phone number, street address, billing address and other information.

● We also may obtain information about you: (a) from your mobile device such as your device type, machine or mobile device identification number, geo-location, time zone, language setting, browser type, and IP address, and (b) from third parties for purposes of transaction processing, identity verification, fraud detection or prevention and other similar purposes. For fraud prevention purposes, we also may link your machine ID with the machines of others who use your same payment cards.

● Financial Information – financial data, financial account data, financial product information, account credentials, bank account and routing numbers and credit cards linked to your user account. We may analyze this information, use this information in or for a comparative context, or combine it with other information from third parties. Billing, Pricing, and Plan Information – data about the price and service plans for your bills, subscriptions, recurring payments, or other payments, along with other information associated with those accounts, including but not limited to account numbers, account credentials, billing addresses, or additional information about your relationship with third-party vendors. Social Media Information – data provided by Facebook and Facebook Messenger if you choose to connect these accounts. E-Commerce Purchase Information – data about historical purchases, including date, item, price, shipping information, billing information, and other related information.

When you are using the Services, we collect information about your account transactions and trust relationships and we may collect information about your computer or other access device for fraud prevention and other similar purposes.

When you visit the website, we also collect your IP address, and standard web log information, such as your browser type and the pages you accessed on our website. We also may collect certain geo-location information. If you do not agree to our collection of this information, you may not be able to use our Service.

We are committed to providing a safe, secure and all around great service. Therefore, we may also obtain information about you from third parties such as identity verification, fraud prevention and similar services.

Finally, we may collect additional information from or about you in other ways not specifically described here. We do not knowingly solicit or collect information from any individuals under the age of 18.

 

Use of Information Collected by Us

Our primary purpose in collecting Personal Information is to provide you with a safe, smooth, efficient, fun and customized experience. We may use your Personal Information to: provide the services and customer support you request; attempt to save you money; negotiate your bills; monitor your telecoms accounts; process transactions and send notices about your transactions or your network activity; resolve disputes, collect fees and troubleshoot problems; prevent potentially fraudulent, prohibited or illegal activities, customize, personalize, measure, and improve our services and the content and layout of our website; send you updates about new products and services that we are offering to customers; compare information for accuracy and verify it with third parties; perform other services as authorized by you; and perform other duties as required by law.

We may use your financial information to facilitate social comparisons of spending patterns and other personal financial matters. We may use your “social graph” information provided by Facebook or other third-party data sources to facilitate these social comparisons. We will attempt to maintain anonymity for users in any social comparisons by displaying only aggregated data across multiple users. However, we cannot guarantee that these aggregate data sets will ensure anonymity.

 

Sharing Personal Information

We do not share your Personal Information with third parties for promotional or marketing purposes. However, we may share your Personal Information with:
● Law enforcement, government officials, or other third parties if we are compelled to do so by a subpoena, court order orг similar legal procedure, when it is necessary to do so to comply with law, or where the disclosure of personal information is reasonably necessary to prevent physical harm or financial loss, to report suspected illegal activity, or to investigate violations of the this Privacy Policy or the Terms of Service, or as otherwise required by law.

● Third party service providers who assist us in providing services to you or who provide fraud detection or similar services.

● Service providers under contract who help with parts of our business operations (for example, fraud prevention, payment processing, or technology services). Our contracts dictate that these service providers only use your information in connection with the services they perform for us and not for their own benefit.

● Businesses or third party websites with whom we are affiliated may sell items or provide services to you through our Services (either alone or jointly with us) and we will share your information with that affiliated business only to the extent that it is related to such transaction or service.

● We may share your information in connection with, or during negotiations of, any merger, sale of company assets, financing or acquisition, or in any other situation where personal information may be disclosed or transferred as one of our business assets.

● Other third parties with your consent or at your direction to do so, including (a) billers whose subscriptions you request us to cancel; (b) banks, credit card issuers, and other financial and non-financial institutions whose fees you request us to contest; and (c) utilities and telecom providers whose rates you request us to negotiate or appeal.

We assume no liability or responsibility for disclosure of your information due to errors in transmission, unauthorized third-party access, or other causes beyond our control.

 

Protection & Storage

We store and process your Personal Information and electronic copies of all correspondence using third party servers located in secure data centers in the United States. This information is protected by physical, electronic and procedural safeguards in compliance with applicable US federal and state regulations. We also use computer safeguards such as firewalls and data encryption, we enforce physical
access controls to our office and files, and we authorize access to personal information only for those employees who require it to fulfill their job responsibilities.

The security of your Personal Information is important to us, and we strive to implement and maintain reasonable, commercially acceptable security procedures and practices appropriate to the nature of the information we store, in order to protect it from unauthorized access, destruction, use, modification, or disclosure. Despite our efforts, we cannot guarantee that personal information may not be accessed, disclosed, altered or destroyed by breach of our administrative, managerial and technical safeguards. Therefore, we urge you to take adequate precautions to protect your personal data as well, including never sharing your user password with anyone.

If we learn of a systems security breach, we may attempt to notify you electronically so that you can take appropriate protective steps. By using the Service, you agree that we may communicate with you electronically. We may post a notice on the website if a security breach occurs. We may also send an email to you at the email address you have provided to us. Depending on where you live, you may have a
legal right to receive notice of a security breach in writing. To receive free written notice of a security breach (or to withdraw your consent from receiving electronic notice of a security breach) you should notify us via email at: info@voluware.com.

 

Log Data

We collect information that your browser sends whenever you visit our Service (“Log Data”). This Log Data may include information such as your computer’s Internet Protocol (“IP”) address, browser type, browser version, the pages of our Service that you visit, the time and date of your visit, the time spent on those pages and other statistics.

In addition, we may use third party services such as Google Analytics that collect, monitor and analyze this type of information in order to increase our Service’s functionality. These third party service providers have their own privacy policies addressing how they use such information.

 

Cookies and Web Beacons

“Cookies” are small data file identifiers that are transferred to your computer or mobile web browser that allow us to recognize your browser or mobile device and transfer information about you and your use of our Services. We use cookies to collect information in order to improve our services for you. You can instruct your browser to refuse all cookies or to indicate when a cookie is being sent. The Help feature on most browsers provide information on how to accept cookies, disable cookies or to notify you when receiving a new cookie. If you do not accept cookies, you may not be able to use some features of our Service and we recommend that you leave them turned on.

We, and third parties with whom we partner, may also deliver a file known as a web beacon, pixel or pixel tag (“Web Beacons”) to you through our Services from an ad network. Web Beacons are small, invisible graphic images that may be used on the Service interface or in emails relating to the Service to collect certain information and monitor user activity on the Service interface, such as to count visits,
understand usage effectiveness and to determine if an email has been opened and acted upon. Web Beacons allow ad networks and service providers that we use to provide anonymized, aggregated auditing, research and reporting for us, for advertisers and our other partners. Web Beacons also enable ad networks to serve targeted advertisements to you when you visit other websites. Because your web browser must request these advertisements and Web Beacons from the ad network’s servers, these companies can view, edit, or set their own cookies, just as if you had requested a web page from their site.

 

Service Providers

We may employ third party companies and individuals to facilitate our Service, to provide the Service on our behalf, to perform Service-related services and/or to assist us in analyzing how our Service is used. These third parties have access to your Personal Information only to perform specific tasks on our behalf and are obligated not to disclose or use your information for any other purpose.

 

Communications
We may use your Personal Information to contact you with newsletters, marketing or promotional materials and other information that may be of interest to you. You may opt out of receiving any, or all, of these communications from us by following the unsubscribe link or instructions provided in any email we send.

 

Compliance with Laws

We will disclose your Personal Information where required to do so by law or subpoena or if we believe that such action is necessary to comply with the law and the reasonable requests of law enforcement or to protect the security or integrity of our Service.

 

Links to Other Sites

Our Service may contain links to other sites that are not operated by us. If you click on a third party link, you will be directed to that third party’s site. We strongly advise you to review the Privacy Policy of every site you visit.

 

We have no control over, and assume no responsibility for the content, privacy policies or practices of any third party sites or services.

 

California Marketing

Under California Civil Code Sections 1798.83-1798.84, California residents are entitled to ask us for a notice identifying the categories of personal information which we share with our affiliates and/or third parties for marketing purposes, and providing contact information for such affiliates and/or third parties. If you are a California resident and would like a copy of this notice, please submit a written request via email to info@Voluware.com.

 

Children’s Privacy

Only persons age 18 or older have permission to access our Service. Our Service does not address anyone under the age of 13 (“Children”).We do not knowingly collect personally identifiable information from children under 13. If you are a parent or guardian and you learn that your Children have provided us with Personal Information, please contact us. If we become aware that we have collected Personal Information from children under age 13 without verification of parental consent, we take steps to remove that information from our servers.

 

Changes

This Privacy Policy is effective as of 10/12/2022 and will remain in effect except with respect to any changes in its provisions in the future, which will be in effect immediately after being posted on this page.

We reserve the right to update or change our Privacy Policy at any time and you should check this Privacy Policy periodically. Your continued use of the Service after we post any modifications to the Privacy Policy on this page will constitute your acknowledgment of the modifications and your consent to abide and be bound by the modified Privacy Policy.

If we make any material changes to this Privacy Policy, we will notify you either through the email address you have provided us, or by placing a prominent notice on our website. Defining what changes constitute a “material change” shall be done at our complete discretion.

 

Restrictions and Monitoring of Our Partners

Your use of the these Services may be subject to separate agreements you may enter into with other third party service providers that we may use to facilitate in the delivery of the Services. These third parties include, but are not limited to: Twitter, LInkedIn, or Facebook.2

 

Contact Us

If you have any questions about this Privacy Policy, please contact us at info@Voluware.com.