Scenario: A top-tier therapy supported by our Hub was experiencing lower-than-expected conversion rates to therapy. Initial analysis pointed to a key barrier: prior authorization (PA) denials, but the root cause remained unclear.
Insights & Hypothesis
Our Hub team proposed a targeted pilot to assess PA follow-up outcomes. The results were striking: nearly 35% of PAs were being denied, often due to inconsistent documentation or misalignment with payer requirements.
Neovance Action
We rapidly implemented a cross-functional workflow between the Hub and the FRM team:
- FRM Intervention Workflow: Our Hub team began following up on PAs and tasking FRMs to follow up directly with offices tied to denied PAs.
- Checklist Development: With the client, we developed a PA checklist that FRMs used to help educate offices on how to submit accurate and complete PAs.
- Resource Allocation: PA outcome data enabled us to prioritize support to the highest-need accounts.
- Targeted Office Education: Offices with high denial rates received tailored guidance from FRMs and the Hub.
Outcome
Within three months, we saw measurable improvement in approval trends. By six months, PA approval rates had increased by 5%, representing a significant gain in patient access and therapy initiation.
Key Takeaways
This initiative demonstrates the power of near real-time data integration, agile operations, and FRM-Hub partnership to unlock meaningful outcomes:
- Offices became more empowered and educated.
- FRMs were able to shift from reactive to strategic support.
- Patients benefited from faster access to therapy.
What started as a pilot evolved into a scalable best practice—showing how targeted, data-informed interventions can drive physician behavior change, improve patient outcomes, and reinforce the value of the Hub and FRM partnership.