Success Story: Medical Device Company
Patient Prior Authorization – Cardiovascular Medical Device Client
Prior Authorization Process Built into Salesforce Slashes Approval Time by 60%
Client is a leading manufacturer of cardiovascular medical devices designed to improve patient outcomes, quality of life, and overall cardiovascular health.
Client had used an external 3rd party to manage Prior Authorization submission, tracking and approval for its medical device products. They were seeking to bring these capabilities in house to increase approval rate, compress approval times, reduce costs, and gain visibility to key performance metrics.
Demand Chain worked with Client to determine the best solution for their needs:
- Process – built a comprehensive, event-driven process into Salesforce covering all stages and substages from initial Prior Authorization submission to final approval, providing visibility at each step.
- Sales Cloud, Service Cloud – internal team can submit a Prior Authorization “case.” Each case is linked to its Sales Opportunity and is embedded in the Sales process.
- Experience Cloud – created portal to allow medical clinics to directly submit a Prior Authorization request.
- Shield – Prior Authorization requests contain sensitive patient medical information. HIPAA-compliant implementation protects patient data via a complete, secure, encrypted path. Only authorized people can access data.
- Custom Objects – for each hospital system, Client has captured all associated resources, including hospitals, surgery centers, clinics, referring doctors, and surgeons.
- Reports/Dashboards – created a comprehensive set of reports and dashboard to provide visibility into performance.
- Speed – Authorization timeline was reduced from a baseline of 80 days to 30 days, slashing average time from submission to final approval by over 60%
- Sales – Authorization approval rate increased from a baseline of 55% to 75%–a 20-point increase in approval rate, increasing sales significantly
- Savings – eliminated costs associated with external 3rd party Prior Authorization vendor
- Access to critical performance data – reports/dashboards provide unprecedented visibility into KPIs such as % of Opportunities requiring Prior Authorization, # of Prior Authorization submissions, initial approval rate, re-submissions and more. They enable Client to actively manage and improve steps in the process.
- Claims tracking & Payment – improved tracking to ensure doctors and hospitals get paid.
Client rated Demand Chain a 5.0/5 on the post-project survey issued by Salesforce.
The Prior Authorization project has been transformative for our organization. Building all functionality into Salesforce has increased process compliance, reduced costs, and provided valuable business insights. Most importantly, we are helping patients needing our devices gain approval faster. Demand Chain has been an invaluable partner in helping capture our process and optimize it on the Salesforce platform. We’re already working with them on enhanced functionality identified during the initial project.
Project Sponsor, Client
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