UX/UI
UX Research
Product Design
This prototype was presented at the 2024 HTLH US Conference.
full case study
what is prior authorization?
The prior authorization process in the U.S. healthcare system requires healthcare providers to obtain approval from a patient’s insurer before providing certain treatments, medications, or services to ensure they are medically necessary and covered. While intended to control costs and prevent unnecessary care, the process is often criticized for causing treatment delays and administrative burdens.
to combat these issues:
A conceptual electronic medical record (EMR) with integrated prior authorization submission was designed. The goal of this product is to help eliminate the issues with the current prior authorization process and allow patients to receive the care and treatment they require without delays.
The following product prototype outlines the product flow from a provider's EMR to Salesforce's utilization management platform.
Screenshots of a fictional EMR that showcases the provider's view of.a patient's chart.
We designed a fictional EMR to showcase the provider's POV when submitting a prior authorization claim for a patient's glucose monitor and three months' supply of glucose and other supplies. The prior authorization integration collects all of the data required for the claim from the patient's chart and autofills the form to be submitted.
Patients also receive real-time notifications via their patient portal app when their provider submits a prior authorization claim as well as when there are updates to the claim's status. Patients can also log in to see what treatments/medications were requested.
Submitted prior authorization request that requires clinical review.
More complex prior authorization claims oftentimes require clinical review by a utilization management nurse or MD/DO. The provider would be notified of this in the EMR and the clinical review request would appear in the connected Salesforce utilization management tool, as shown below.
View of the prior authorization request in Salesforce utilization management tool.
Similarly to submission and approval update push notifications, patients will also receive notifications and be able to view their pending authorizations via their patient portal app.