Lifestyle

Healthcare Leader Avantika Sharma Reveals How Digital Tech Solutions Can Improve Prior Authorization Procedures

Published

3 years ago

January 25, 2023

One of the most necessary and standard procedures in the healthcare industry is Prior Authorization (PA), which requires healthcare providers to obtain approval for a treatment or medication before delivering it to a patient. Unfortunately, PA is also one of the most inefficient processes in the healthcare industry and is currently facing a crisis.

This year, 70% of medical groups attested that PA claims increased, yet, at the same time, a study by the University of Colorado found that 93% of providers reported delays in care due to drawn-out PA processes. In short, claims are increasing, and one of the side effects is that delays are becoming more notable, if not longer. This is due to long-standing inefficiencies and problems swept under the rug for years, resulting in longer patient waiting times, increased burden on administrative staff, and even physician and clinician burnout.

At Brillio One Health, Healthcare Leader Avantika Sharma and her team are working towards streamlining and optimizing healthcare systems like PA to benefit healthcare providers, insurance payers, and, of course, patients. They work with international healthcare organizations to “covert digital disruptions into solutions that can position payers and providers ahead of the curve.”

She views the current workflow required to obtain PA for a procedure or treatment to be an area that requires extensive digital reform. According to Sharma, “technologically automating the Prior Authorization process at the level of providers and payers can drastically improve the patient experience by getting on-time approvals before surgery and reducing operational and administrative costs.”

The PA process is currently plagued by administrative complexities, time-consuming manual procedures, liabilities due to human error, and excess use of valuable resources. To illustrate, most documents are faxed or emailed and require physical signatures, even though the digital resources to replace those aspects of the process are well established. Not to mention using manual technologies to transmit documents has already been proven to be more likely to lead to incorrect information, missing documents, and excessive back-and-forth communication.

All that communication is done by large teams of administrators, who spend considerable time sorting and verifying numerous documents from different sources. This puts a huge burden on hospitals and insurance companies to staff those teams accordingly. It also contributes to complexity and redundancy on an administrative level.

There are also confidentiality issues that come with using manual systems to complete PA claims. According to Sharma, “using fax to transmit prior authorization forms minimizes the legal requirement to keep medical information confidential since it involves the production of a printed piece of paper that can be easily seen or taken by anyone walking past the machine when it prints or someone’s desk where it is awaiting processing.”

Even more alarming is the lack of coordination between the systems used by payers and providers. Despite the amount of communication required between these two entities to get a single claim passed, the current systems can vary from one organization to another. For example, 15 different providers might use 15 different websites, each with unique software and login information.

Sharma believes that adopting digital solutions on the part of providers and payers could result in major improvements in the PA process. Brillio’s human-centric approach includes the design and implementation of systems powered by Artificial Intelligence (AI), Machine Learning (ML), and Natural Language Processing (NLP), among other technologies. These innovative systems are already present in our daily lives but can be combined to create efficient, constantly evolving solutions that benefit the healthcare industry.

Proposed solutions would certainly include the creation of standard systems for communication between payers and providers. An example of this is online portals and digital software that is standardized across all platforms. Optimizing this software would allow relevant personnel from both the medical and the insurance side to use their secure username and password to access the same PA documents, at different stages of the process. Other solutions might be using NLP to convert doctors’ notes into text compatible with online forms or using AI to develop approval processes for documents, thereby cutting down on the administrative staff needed to verify every signature or document in a PA claim file. Using electronic signatures, electronic health records (EHR), and opting for digital file sending are all essential solutions as well.

These solutions would be one piece in a larger movement that could radically change the healthcare industry in the United States. One rule introduced in early December 2022 by the Centers for Medicare and Medicaid Services included the implementation of electronic PA processes for document attachments and signatures. It also included the required adoption of a Health Level 7 (HL7) Fast Healthcare Interoperability Resources FHIR standard Application Programming Interface to support new digital systems. CMS predicted that implementing better digital systems, alongside other proposed solutions, for PA could save more than $15 billion over 10 years.

Most importantly, Sharma highlights the importance of putting the patient first. Lengthy PA processes can take days, if not weeks, to go through, and only a tiny fraction of them are approved without delays. Most PA claims are denied at the outset and require appeals and negotiation. A patient-centric healthcare system focuses on making sure sick people are given the care they need, when they need it, without waiting for their doctors and insurance providers to jump through hoops.

For more information, visit www.brillioonehealth.com.

Lifestyle

Roger E. Pedersen: The Visionary Behind SuperPower: The Ability to Fly or to Become Invisible book series

Published

10 hours ago

August 14, 2025

Michelle Langton

In the ever-expanding world of speculative fiction, few authors manage to strike a balance between thrilling storytelling and intellectual depth quite like Roger E. Pedersen. A former video game designer with a penchant for weaving together elements of history, humor, and pop culture, Pedersen has captivated readers with his SuperPower series. His latest installment, SuperPower: The Ability to Fly or to Become Invisible: The Golden Eagle Has Yielded, continues to explore the ethical, societal, and personal implications of possessing extraordinary abilities.

Pedersen’s journey into writing was anything but conventional. Five years ago, his career in video game design took an unexpected turn when his division was relocated, leaving him without a job. Struggling with financial hardships, homelessness, and personal loss, he found solace in storytelling.

“I was reading about J.K. Rowling’s struggles before she became a best-selling author. At the same time, I came across an article in Forbes magazine and This American Life that posed the question: ‘If you could have a SuperPower, would you choose to fly or become invisible?’ I realized that no one had explored this idea in depth in literature,” Pedersen recalls. Instead of succumbing to his dire circumstances, he began writing what would become his first book in the SuperPower series.

Pedersen’s writing method is as unorthodox as his journey. He envisions his stories as movies playing in his mind, dictating them into his phone using speech-to-text technology. His drafts go through meticulous refinements using Microsoft Word and Grammarly, ensuring an engaging and well-structured narrative. His storytelling prowess has been met with critical acclaim, as evidenced by his previous books, which have received five-star reviews and awards.

The SuperPower series delves into profound moral dilemmas. If given a SuperPower, would individuals use it for good, or would temptation lead them astray? Pedersen’s books examine these questions through the lens of two rival organizations: The Golden Eagle, led by Professor Steele, and DODGE (Department of Defense Genetically Engineered Initiative), a competing faction.

The first book introduces readers to a group of SuperPowered individuals who execute a meticulously planned heist of $3.5 billion worth of artwork from some of the world’s most prestigious museums, including the Louvre, the Tate, and the Metropolitan Museum of Art. The narrative is enriched by Pedersen’s deep knowledge of art history, allowing readers to learn about masterpieces in an engaging and unexpected way. Beginning with the second book of the SuperPower series, The Next Generation, all characters can either fly or become invisible, plus they possess another SuperPower.

Pedersen’s books are brimming with memorable characters, many of whom are inspired by his own family and personal experiences. Michele, one of the protagonists, grows up under the immense pressure of her Olympic champion mother. She suffers a devastating injury but later discovers her ability to fly during a long jump event at the Olympics—an emotional and breathtaking moment that brings readers to tears.

Other characters, such as Michael Roberts, a former dishwasher who gains the power of invisibility and leverages it to succeed on Wall Street, and Ryan Loki Patel, a prankster who uses his abilities to mischievously alter museum exhibits, add humor and depth to the narrative.

These diverse and well-crafted personalities make the SuperPower series more than just a superhero saga—it’s an intricate exploration of human nature.

With six books planned in the series and more SuperPowers to be unveiled, Pedersen’s SuperPower universe continues to expand. His ability to merge humor, history, and philosophy with compelling storytelling makes his work stand out in the realm of speculative fiction.

Beyond the fast-paced action and humor, Pedersen’s work deeply examines the implications of power. His characters face real-world ethical dilemmas, forcing them to confront their own values. The SuperPower series raises questions about how society perceives power and how it might be used in different hands, whether for personal gain, justice, or something more ambiguous.

Professor Steele, one of the figures in the series, embodies this theme as he orchestrates strategic power plays between the SuperPowered factions. His complex relationship with the Steele twins—characters who are thought to be dead, only to be resurrected—adds an element of mystery and intrigue to the saga. Through this, Pedersen plays with philosophical themes of fate, destiny, and the weight of responsibility.

Moreover, the series doesn’t shy away from questioning what it means to be a hero. Unlike traditional superhero narratives where good and evil are clear-cut, Pedersen presents a morally grey world where each character is forced to make difficult decisions.

For those who love books that challenge the imagination while offering a fresh take on the superhero genre, SuperPower: The Ability to Fly or to Become Invisible is an unmissable read.

Roger E. Pedersen’s journey from hardship to literary success is as inspiring as the stories he tells, making him a standout voice in modern speculative fiction.

As Pedersen continues to build his SuperPower universe, readers can look forward to a series that not only entertains but also provokes deep reflection. His ability to craft intricate, well-researched narratives while infusing them with humor and emotional depth ensures that his books remain both engaging and memorable. Whether you are a fan of speculative fiction, a lover of intellectual storytelling, or someone seeking a thrilling, unconventional series, Pedersen’s SuperPower books are sure to captivate your imagination and leave you eagerly anticipating the next installment.

The entire SuperPower book series is available in paperback, eBook, and audiobook formats through Amazon, Google Play, Barnes & Noble, Kobo, Apple, Target, Walmart, Waterstones, and hundreds of local bookstores.

Website: PSIPublish.com (link to StoryRocket.com)