by Joel French, CEO of SCI Solutions
Harvard Business School professor Michael Porter said the following after years studying health care delivery in the U.S.: “Ultimately, health care fails the most basic test. It’s not organized around the needs of the patient.”
SCI’s organizational purpose is to improve the health of the health care system and the communities it serves. Earlier this week, we announced the acquisition of Clarity Health, a company that delivers insurance authorization and referral management services to more than 100 health systems, ACOs, imaging centers and physician practices nationwide. Our combined organization now delivers an unmatched ability to help provider networks and health systems become easier to access for referring providers, and grow market share.
Insurance prior authorization requirements have been a burden to patients receiving care – often requiring patient appointments to be rescheduled, delays of needed diagnostic studies and frustrating administrative steps that adversely impact patient satisfaction scores. Referring practices spend thousands of hours each year interacting with insurance companies in attempt to obtain authorizations on behalf of their patients. Destination providers rendering services to referred patients, likewise, spend thousands of hours seeking to obtain authorizations and are subject to reimbursement denials if these rules are not followed precisely. Collectively, health systems and providers spend $20 billion per year interacting with health insurance companies regarding billing issues and authorizations. Lack of prior-authorizations and eligibility are the leading causes of payment denials from commercial payers – typically a hospital’s most profitable category of reimbursement.
SCI now delivers within its existing referral, order and patient scheduling workflows a richly integrated insurance processing and authorization service to solve this problem for providers and patients alike. As an independent, neutral intermediary, SCI provides this service for all insurance plans across all markets.
The impetus for this investment was our belief that community care coordination is an essential component of value-based care. We already see significant demand for this service. The care coordination market segment is expected to grow considerably in the next five years – Frost & Sullivan projects compound annual growth of 26 percent – and health systems and providers will be looking to purchase technologies and services that help them better manage these transitions of care that take place across a community and for all patients.
These strategic capabilities have already been validated by substantial sales of the integrated SCI/Clarity offering to SCI clients and prospects, based on a distribution and technology integration agreement the companies executed in 2014. We are confident that our long, successful track record in patient access with market-leading solutions for patient scheduling and orders management, coupled with Clarity’s strong experience in referral management and insurance authorization, strengthens our clients’ abilities to enhance market positions and construct advantage in patient care coordination.