Sunrise Case Study
Introduction
Company: Sunrise
Industry: Digital Health
Challenge: Sunrise faced time-intensive medication prior authorization processes and unreliable data tracking, leading to operational inefficiencies and risk of therapy lapses for patients.
Solution: Develop Health's AI-driven tool streamlined form fill times by nearly 50%, integrated directly with Sunrise's CRM for real-time updates, and provided data analytics for optimized decision-making across the board.
Sunrise, a leading digital health company, specializes in weightloss care and prescribes GLP-1s and other drugs. In their quest to enhance their medication prior authorization process, they collaborated with Develop Health. Leveraging Develop Health's robust integration capabilities, Sunrise seamlessly tapped into both structured and unstructured patient data within their EHR, optimizing their prescription process and amplifying patient outcomes.
"If I were to describe the transformational change brought about by Develop Health, I'd highlight how we've taken control of the prior authorization process. Through holistic integration, from auto-suggested answers to in-depth analytics, we've initiated a virtuous cycle of continuous improvement. Develop Health has become an indispensable pillar in the Sunrise toolbox. It's reshaped the way we approach medication authorization, benefiting not just our operational efficiency, but our patients as well."
– Keaton Bedell, Head of Operations
The Challenge
Before implementing Develop Health's tool, the Sunrise team faced several challenges:
- Time-Consuming Processes: The team spent considerable time manually filling out forms, and the inherent inefficiencies affected overall productivity.
- Data Integrity Issues: Tracking PA submissions and outcomes in their previous system resulted in human errors, rendering the data messy and unreliable.
- Operational Inefficiency: Without an integrated solution, staff grappled with multiple challenges. They had to constantly check prior authorization statuses, manually handle and categorize inbound faxes, sift through them for determination data and reasons for denial, and then tediously update the CRM. This consumed valuable time and led to unexpected lapses in therapy for patients.
The Solution
Sunrise turned to Develop Health, an AI-driven solution to streamline and optimize the medication prior authorization process. What distinguished Develop Health was its ability to:
- Streamlined Workflows: Develop Health suggests multiple choice and free-text answers and aids the prior authorization specialists in validating answers swiftly. Determination status auto-updates in the CRM, eliminating manual checks.
- Analytics Powerhouse: Advanced analytics from Develop Health made a notable difference for Sunrise. They could track PA submissions by patient, PBM, medication, and agent. This data-driven approach enabled optimization at various levels—from training agents to updating upstream workflows.
- Fax Management: Develop Health effectively managed and categorized inbound faxes, consolidating determination data.
- Proactive Re-Authorizations: The system signaled when a prior authorization was nearing expiration, facilitating timely reauthorizations.
The Impact
Through the adoption of Develop Health's platform, Sunrise experienced significant improvements in their prior authorization processes:
- Efficiency Gains: There was a notable reduction in form fill times, achieving a significant 50% improvement. Furthermore, with Develop Health's capability to directly write determination statuses back into the CRM, the manual and periodic checks became a thing of the past.
- Enhanced Analytics: Develop Health's in-depth analytics allowed Sunrise to optimize multiple facets of its operations. This includes:
- Tracking prior authorization agent performance, pinpointing areas for training optimization.
- Streamlining intake questionnaires and treatment plans by analyzing determination data.
- Refining PA submission strategies leading to improved approval rates. By analyzing trends and feedback, they could determine what additional content to include in submissions and the most effective format to use, further tailoring their approach to meet specific insurer criteria.
- Value Addition: Sunrise's use of Develop Health’s product enabled them to scale their prior authorization submissions in quantity and quality. This bolstered their commitment to offering unrivaled value to their patients.
- Rapid Feature Implementation: Custom features suggested by Sunrise were swiftly incorporated, often within days, indicating Develop Health’s commitment to a tailored solution.
“Honestly I can't imagine Sunrise without the Develop product. The product gives us much more control over the prior authorization process—be it autofilling answers or analytics. We're now able to enhance patient value by optimizing both the volume and quality of our prior authorization submissions in a way that is hard to beat."
– Allie Lahey, Clinical Support Specialist
Conclusion
Develop Health's AI-driven platform proved instrumental in transforming Sunrise's medication prior authorization process for weightloss drugs. With tangible improvements in efficiency and insights from advanced analytics, Sunrise solidified its position as a technologically sophisticated provider. The collaboration underscores the potential of harnessing AI in healthcare, driving operational excellence, and, most importantly, elevating patient care.
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