Jacksonville-based Availity has partnered with a fast-growing Ohio health tech company to form what it says is the largest integrated prior authorization network in the industry.
The tools created by PriorAuthNow of Columbus speed up the process of getting insurer sign-off on authorizations for hospital procedures and prescriptions — a laborious process still dependent on phone calls and faxes.
For Availity, the strategic partnership is an expansion of the way it brings products to market. While the health plans that the Jacksonville company works with can build proprietary applications and distribute them through its network, “PriorAuthNow is really a great example an early example of doing that at scale with a true third-party partner,” said CEO Russ Thomas.
“They're bringing technology, they're bringing product,” Thomas said, “and we're bringing market share and a sales organization, a distribution platform, our marketing machine and all of that.”
For PriorAuthNow, the value of the partnership is reaching not just an expanded customer base but having more data for its machine-learning algorithm to work with: Availity processes some 40 million transactions a day.
The Ohio company’s product automates some of the decision making around authorizations. A study by CAQH, an industry organization focused on simplifying healthcare administrative transactions, found that the software cuts authorization time by 91%, with a quarter of the decisions requiring no human involvement.
The system works because of how the company deals with data, Thomas said: While health care systems do a good job with structured data, he said, PriorAuthNow’s technology allows it to process unstructured data, like doctor’s notes, in making a decision.
The partnership comes as Availity expands its executive team with a focus on growth.
Founded 20 years ago as a joint venture by Florida Blue and Humana, the company is now owned by the nation’s largest health care plans as well as by Novo Holdings, an investment fund that bought it stake in the company last year.
Earlier this month, the company added a chief strategy officer to its executive team, bringing on former McKinsey & Co. Associate Partner Nathan von Colditz. His background at McKinsey and, previously, at PwC’s Strategy& consulting unit focused on health care and information technology.
Last year, the company hired healthcare and business development veteran Leslie Antunes as its chief growth officer. Antunes is leading the PriorAuthNow sales initiative.
PriorAuthNow has also been expanding. Last year, it beefed up its executive team, bringing on a COO and expanding its headcount by more than 20%, moves that came after a $10 million round of funding raised in 2020.
For Availity, more partnerships may be on the way.
“We always go through the build/buy partnership assessment when bringing new capabilities to market,” Thomas said. “If we can’t build it or it’s not something we should build, we’re finding the best possible partners to do that. And that process, frankly, will continue to mature.”
