Market: Family Health Managers managing their family's healthcare needs
Scenario: Patient navigates the burdensome process of obtaining prior authorization for a medication. She manages doctor communication, tracks insurance approvals, coordinates with pharmacies, and resolves denials, all while balancing her family's health needs and a demanding schedule.
Average Difficulty: Intense (30%+ Range).
31 Outcomes 30% to 62% Difficulty.
The research highlights significant frustration around delays, lack of clarity, and communication gaps in obtaining prior authorizations. Family health managers struggle with doctor-pharmacy-insurance coordination, unclear denial reasons, and ensuring timely medication access. Family health managers desire streamlined, transparent processes that reduce delays, clarify approval steps, and improve communication between involved parties.
Job steps are the current sequential steps that the market goes through to accomplish this job.
1. Get a prescription from my doctor
2. Find out the pharmacy needs approval from insurance
3. Make sure my insurance covers the medicine
4. Wait to hear back from insurance
5. Follow instructions from insurance
6. Keep track of approvals and renew them if needed
The difficulty percent below are the percent of the market that finds this outcome difficult to achieve.
Difficulty | Outcome |
---|---|
62% | Decrease the difficulty of planning for ongoing medication refills |
60% | Increase the clarity of doctor communication about prior authorization |
60% | Increase the clarity of steps needed for recurring medication refills |
51% | Increase the ease of contacting the doctor for prescriptions |
51% | Increase the consistency of refill approvals for chronic conditions |
50% | Decrease the time it takes for pharmacies to notify about rejections |
50% | Decrease the time it takes to get forms submitted to insurance |
50% | Decrease the difficulty of getting emergency approvals for life-saving medications |
48% | Increase the ease of accessing mail-order pharmacies for rare medications |
48% | Increase the consistency of insurance approvals for recurring medications |
47% | Increase the ease of preemptively submitting prior authorization forms |
45% | Decrease the difficulty of accessing alternate pharmacies for approvals |
45% | Decrease the time it takes to get emergency medication when approvals are delayed |
44% | Decrease the cost of emergency medications during approval delays |
41% | Increase the ease of tracking insurance approval statuses |
41% | Decrease the difficulty of coordinating with multiple pharmacies for prescriptions |
40% | Increase the ease of accessing status updates for approvals |
40% | Decrease the time it takes to identify prior authorization requirements |
40% | Increase the clarity of insurance requirements for specific medications |
40% | Increase the ease of understanding approval or denial notices |
37% | Increase the clarity of insurance coverage policies |
36% | Increase the consistency of approval communications between doctors, pharmacies, and insurance |
36% | Decrease the difficulty of understanding insurance denial reasons |
35% | Decrease the difficulty of knowing which medications require prior authorization |
35% | Decrease the time it takes for doctors to complete prior authorization forms |
35% | Decrease the time it takes to resolve communication gaps between parties |
35% | Decrease the frequency of delays caused by missing forms |
33% | Increase the clarity of pharmacy notifications about prior authorization requirements |
32% | Increase the ease of resolving approval denials |
30% | Decrease the time it takes to get a prescription approved when insurance requires prior authorization |
30% | Decrease the difficulty of transitioning between insurance plans |