![MetroHealth Authorization Success: 173% Increase [Case Study]](https://www.experian.com/blogs/healthcare/wp-content/uploads/2025/12/Blog_CaseStudy_MetroHealth_20251229.jpg "MetroHealth Authorization Success: 173% Increase [Case Study]")
Streamlining Prior Authorization: How MetroHealth Achieved a 173% Increase in processing Volume
Prior authorization. For many healthcare systems, those two words evoke frustration, administrative burden, and potential delays in patient care. But what if prior authorization coudl be managed – even become a strategic advantage? MetroHealth discovered it could, and the results are compelling. this case study details how they transformed a chaotic,reactive process into a predictable,efficient workflow,boosting capacity and improving both patient experience and financial performance.
The Prior Authorization Challenge: A Common Pain Point
Healthcare organizations grapple with a growing complexity of payer rules and a rising volume of prior authorization requests. Manual processes, siloed interaction, and constant portal-hopping are all too common.This leads to staff burnout, increased denial rates, and ultimately, compromised patient care. MetroHealth faced these same challenges, struggling to keep pace with the demands of a growing patient population and expanding service lines.
The Solution: A Unified Workflow with Experian Health Authorizations
MetroHealth partnered with Experian Health to implement their Authorizations solution, a platform designed to centralize and automate the prior authorization process. This wasn’t about simply digitizing existing workflows; it was about fundamentally changing how authorizations were handled.
The core benefit? A single, streamlined workflow capable of processing a wide range of authorization types. This eliminated the need for staff to navigate multiple systems and communication channels, a significant source of wasted time and potential errors.
Beyond workflow efficiency, Authorizations’ Knowledgebase proved invaluable. Instead of relying on guesswork,staff now have access to a continually updated libary of payer rules,maintained monthly by Experian Health. The ability to add custom rules for unique payer requirements further empowers MetroHealth with greater control and accuracy.
Dramatic Results: from firefighting to proactive Management
The impact of the Experian Health Authorizations solution was immediate and significant. Here’s a snapshot of the key improvements:
* Authorization Volume: A remarkable 173% increase, jumping from 2,200 to 6,000 monthly transactions.
* Proactive Planning: Teams now initiate authorizations 30 days before scheduled services – a 114% increase from the previous 14-day window.
* Efficiency Gains: Average time per authorization request plummeted from 10 minutes to under 4 minutes.
* Faster Follow-Ups: Follow-up processes are now 50% faster.
* Expedited Reviews: Peer-to-peer reviews are completed 4-5 days sooner.
These aren’t just numbers; they represent a essential shift in how MetroHealth approaches prior authorization. Staff are no longer bogged down in repetitive tasks, freeing them to focus on complex cases and exceptions. The extended lead time allows for proactive case management, minimizing denials and delays.
Capacity Without Cost: Scaling to meet Demand
Perhaps the most impressive outcome? MetroHealth was able to more than double their authorization processing capacity without adding headcount. the system’s efficiency and automation allowed the existing team to handle a substantially larger workload, supporting expanded service lines and increased patient volumes.
This translates to faster decisions for patients, reducing anxiety and ensuring timely access to care. Clinicians also benefit from quicker peer-to-peer reviews, alleviating administrative burdens and allowing them to focus on patient care.
Key Takeaways: Building a Manageable Authorization Process
MetroHealth’s success wasn’t simply about implementing new technology. It was about a strategic approach focused on empowering their team and optimizing their processes. Their experience highlights three critical elements:
- Early Alignment: Involving the right stakeholders from the outset ensures everyone understands the workflow and shares common goals.
- Data Accessibility: Making critical information readily available - like integrating CPT codes directly into the system – eliminates time-consuming searches and reduces errors.
- Ongoing Investment: Complete training and continuous communication are essential for maximizing the solution’s value and fostering user adoption.
Prior authorization doesn’t have to be a source of constant headaches. By embracing a unified, automated approach, healthcare organizations can transform this administrative burden into a strategic asset.
Learn more about how Experian Health’s Authorizations solution can definitely help your association reduce manual effort, improve cash flow, and deliver a better patient experience. [https://www.experian.com/healthcare/products/patient-access-registration/prior-authorization-software](https://www.experian.com/healthcare/products/patient-
