‘We're all going to have to get smarter’ — Using tech to combat patient confusion, enhance access and bolster the health care workforce

Prior authorizations (PAs) and confusing processes in health care sometimes make patients postpone or abandon treatments and therapies they need.

It’s bad for patient outcomes and for health care at large, and it’s significant — at least 21% of patients delay starting their prescribed medications, according to a national survey published this year. “Patient Access Barriers 2026,” published by D2 Solutions, a consulting and technology company based in St. Charles, Missouri.

Additional findings include:

• 22% of patients said the PA process took significantly longer than expected
• 38% of patients said they received little or no communication while waiting for medication approval
• 47% of patients said that lack of transparency left them feeling anxious and uncertain
• 46% of patients were unaware of manufacturer support programs
• 15% of patients reported using one of the manufacturer’s programs

D2 Solutions President and CEO Dean Erhardt spoke with Medical Economics about the survey results, patient access to health care, and the workforce shortage. The good news: Expect more patients to become more comfortable using elements of digital technology across health care, including artificial intelligence (AI). The challenge: Physicians and their support staff need to keep up with them.

This transcript has been edited for length and clarity.

Medical Economics: D2 Solutions has published the results of a survey about patient medications and prior authorizations. Can you talk about how that survey came about, and some of the results?

Dean Erhardt: We work with a lot of different manufacturers who have products that require prior authorizations, and we have developed some software to solve some of those issues. Because what we see in so many instances is that a [PA is submitted on a standard form created by a payer, and it gets denied, and the entity that submitted that PA, be it a physician office, a hospital pharmacy, a specialty pharmacy, or whomever, doesn't necessarily get told why it was denied. So now you're essentially guessing as to why it got denied and what you need to do to get it approved.

One of the challenges we have, of course, is that when you look at the information coming out of the AMA (American Medical Association), even their survey data, they talk about the challenges with PAs. And what we see is that there's really no reason, other than structural and infrastructure challenges, that a PA should be delayed two, three or four days. We've talked to manufacturers who have products delayed as long as three to four weeks. But if you solve for the problem up front, which means getting the payer the right information from the start, you can cut that time down to virtually nothing. And that's really where we're trying to help people focus.

Medical Economics: Our physician audience are the ones requesting prior authorizations for their patients. Physicians and patients may feel an adversarial relationship when there's a denial. Can you talk about that?

Dean Erhardt: I think that's easy to feel, because again, sometimes those denials come back without even telling you why it was denied. And then when you talk to somebody at the payer — that skill set can be all over the board. So you may talk to somebody who says, "Yes, provide this and it'll get approved," and then it still gets denied. And the next time you call, someone else says, "Well, no, that's not really what we needed, we needed something else." So the rules of the road are not always clear, the documentation that's required is not always clear. Part of this process, for us at least, is defining it up front.

What we did is develop software that looks specifically at a given product-payer combination. A given product may have different requirements depending on whether you're submitting to payer one versus payer two versus payer three. So what we've done is examine those individual requirements to make sure that when you're submitting, you're submitting in accordance with those exact specifications.

The other thing we've done is create a model that can identify when you're out of range or missing information. Using myself as an example, I might write down St. Louis, Missouri, where I live, along with my ZIP code, but my ZIP code doesn't actually match St. Louis because I live in a suburb, not in the city itself. By catching those types of errors and correcting them up front, you eliminate a lot of what happens on the payer side, where submissions get rejected for those kinds of errors. And the vast majority of those errors are really administrative in nature, not clinical in nature.

Medical Economics: The survey found that 21% of patients delayed starting a prescribed medication due to confusion or access issues. Do those access issues and confusion stem from prior authorizations, or are there other factors?

Dean Erhardt: For the survey that we looked at, it was largely around prior authorizations and that confusion, really, for the patient. There are a lot of issues. The first is they simply don't know what's going on. Think about this: In many cases, I've just been diagnosed with a fairly major, significant disease. I'm getting calls from my physician's office, from a pharmacy, from a payer. I'm getting a lot of input, and none of these people really speak the same language, tell me the same thing, or are consistent in what they're trying to guide me through.

So what we're really working through is: How do we connect with that patient in real time at the physician's office and then guide them through this process so that it becomes smooth across the entire spectrum? So they know, "Hey, we need to talk to you at the physician's office because we need three more questions answered." Or, "Your prior authorization has been submitted to payer X, but it takes at least 48 hours to get information back."

In many cases, these patients don't even know who to call when they have questions. So they might call their physician's office. But we know physician offices are largely understaffed and incredibly busy. And now they're trying to call that patient back, and it might take six, seven, eight, nine phone calls before they actually connect.

What we're really trying to solve for is how we address that through a digital component. So we can auto-schedule that call with the physician's office, and enable that patient to get answers to maybe 20 questions before they ever get there: What is the status of my medication? When can I expect it? Do I need to pick it up at retail, or will it be delivered to my home? What will my cost be? All of those things a patient doesn't know, we're trying to solve for those earlier in the process. And by the way, what if that patient just found out they're going to have a $200 coinsurance and can't afford it? Did they know there might be a copay program or an affordability program available? I think the survey speaks to what a large percentage of patients don't even realize those types of services exist.

Medical Economics: There are times when a software solution or a computing platform may not be realistic for those physicians who may not have a lot of money to invest because they are in a smaller office. How can they smooth out that process so that the patient feels more informed?

Dean Erhardt: I think if you're talking about the investment side, there's got to be a balance between how much time you're saving in labor versus how much you're spending on technology. The other side of that coin is that labor tends to be highly variable. If somebody is on vacation, or, as happens many times, somebody leaves a job, all of a sudden you don't have a reimbursement case manager anymore because the best person in your office just took another job down the road. So there are a lot of unseen costs that physician offices don't necessarily recognize that really do drive a lot of this activity.

The other thing is, you've just got to make it easier to use. There shouldn't be a long training process or program. What we see is that if we can get a physician's office onto a platform and get them on the phone for 15 minutes, we can have them trained on how to use the system. It's got to be very intuitive and very easy to use. That makes it easier for their staff, but it also starts cutting down on staff time, which ultimately cuts down on their overall cost structure.

Medical Economics: Do you think technology is going to be a panacea for the shortage of physicians and health care workers that we have?

Dean Erhardt: I think it has to be. Because if you take a look at what the numbers tell us, physician shortages, nursing shortages, general health care worker shortages, we're going to have a dramatic shortage by 2030 and beyond. And if technology doesn't address this, we're going to have a significant number of people, including myself, who are getting older and, as we know, need more services as they age. How are they going to get those services if there aren't enough people there to provide them? That answer is going to come with technology.

Now, the good news is, we talk about how older people maybe aren't adapting as much to technology, but that's going to change dramatically in the next five years. The reason is simple: The people coming into retirement now, roughly ages 58 to 64, have really been exposed to technology for the last 30 years. We've worked most of our careers on laptops, and to a large degree on cell phones, smartphones and iPads. So we're not as cautious about technology and technology solutions as the generation above us. I think that adaptability will be significant.

Plus, as we see with digital therapeutics and other digital products, technology is going to be more involved in simply delivering health care services. And what is the value of that? We work, as an example, with a migraine product that is a technology you wear on your arm. Now a patient can resolve a significant amount of their migraine problems with a product that has no chance of side effects, because they're not ingesting anything. As more and more of those technologies become available, I think more patients are going to get more comfortable with the idea that, yes, they can talk to an AI agent, but they can also use digital therapeutics, wearables and other tools to enhance their overall health care experience.

Medical Economics: One of your ideas about a solution to the health care workforce shortage is to upskill existing employees. Can you talk about that concept, how it's going to work, and especially how you can apply it in a smaller practice?

Dean Erhardt: Well, the reality is that with the advent of AI and the speed at which we're seeing technology move forward, we're all going to have to get smarter. We just don't have a choice: It's either get smarter or get left behind. I like to use the horse and buggy analogy: I could still be riding my horse, but that car is going to pass me at 60 miles an hour. Well, if AI is going to pass me at 60 miles an hour, I better learn how to use it and get comfortable with it.

I know you're talking about independent physician offices that are somewhat financially constrained, if not significantly financially constrained. But I do think they're really going to have to take a look at what they need to invest in. And it doesn't necessarily mean millions of dollars. Maybe it's a couple of classes twice a year for employees to upskill around AI and other technologies that are simply going to move forward whether you like it or not. And if you don't enable your staff to be a part of that, to be able to utilize that skill set, it's actually going to get more expensive over time, because the technology is going to be up here and your skill set is going to be down here. If you don't keep that skill set moving forward, you're going to run into a problem. And I think that problem is not that far away.

Medical Economics: What would you like to see for primary care investment?

Dean Erhardt: I think part of that is location, location, location. We are seeing more and more health care deserts where there isn't a doctor in the geographic area, and there may not be a pharmacy or a pharmacist in the geographic area either. So I think one of the questions becomes: How do we reach patients from those desert areas, and how do they interact with primary care? And does that primary care physician, who may be the closest one available and still 75 miles away, create a day a week, or a half day a week, or a day every two weeks, where they effectively serve as a telehealth provider? That way they can facilitate health care for people in that desert.

I just think we've got to rethink how we're doing some of these things, based on the geography of what's going on in the marketplace as a whole. And again, thinking about patients in general. If they don't want to physically go in and see a doctor because it's just inconvenient for them, as much as we might want to say, "Look, it's in your best interest to see a doctor" — and I'm a firm believer in that — but if people get it in their mind that they can't take three hours off work to go see a doctor because they're paid an hourly salary and are barely getting by, then we have to show the flexibility to be able to service that patient.

Medical Economics: What did I not ask about the survey that you'd like our audience to know?

Dean Erhardt: I just think health care access in general is getting more and more challenging for a lot of individuals, and we've really got to take a look at how we make it easier for patients to access the services they need. The survey, notwithstanding, tells a story. What story does it tell? It tells a story that patients can't always easily access health care, and even when they do, it's large, it’s confusing. And look, you and I are in the middle of it all the time and can maybe guide our way through it. But for the person who goes into a physician's office, gets referred to a specialist, and suddenly finds out they have a disease that costs $250,000 a year to treat — what do they do?

So I think the one takeaway I want people to really think about is: How do we make that transition easy enough and understandable enough for a patient, so they can be guided to the best possible care without simply walking away because they're confused?