Case Study
How Arches Primary Care Cleared Its Prior Auth Backlog With Develop Health
An independent primary care group ran ~800 prior auths in six weeks on Develop Health, cutting turnaround from weeks to two days.
prior auths submitted in the first six weeks
of staff time saved every week
turnaround on a prior authorization
The Starting Point: A Lean Practice, With Prior Auth Breaking Down
Arches Primary Care is one of the largest independent primary care groups in its region. Like most independent practices, it runs lean and staying independent is the whole point. When Kenny Correia, PharmD, joined as Director of Pharmacy about a year ago, the prior authorization process was breaking down.
Medical assistants and front-desk staff handled the prior auths. They had little medical training, so the medical questions tripped them up, and the work kept bouncing back to providers who were already burnt out. Denial rates sat around 80%. Patients waited weeks for their medications, when the prior auth got submitted at all.
"Patients weren't getting their meds, things were taking weeks on end, and everyone involved was just frustrated."
Kenny had run prior authorizations at a previous practice, but there he had two technicians doing it full time. At Arches there was no budget for extra staff, so he absorbed the entire load himself. The work landed in his downtime, which mostly meant dinnertime.
Finding Develop Health
Kenny already leans on AI across his day, from chart review to pre-visit planning. Prior auth was the one piece still done by hand. So he set up a Google alert for "prior auth assistant for Athena AI" and left it running. It sat quiet for months. When it finally fired, it pointed to Develop Health in the Athena Marketplace, available for free.
"Here I am just manually typing things into SureScripts and CoverMyMeds, and I'm like, there's gotta be a better way. Someone has gotta figure this out."
He set it up himself in two days, before his onboarding call. By the time the team walked him through the settings, he'd already been live for 48 hours.
"The fact that I could even set it up that quickly says a lot. I've been absolutely impressed with how easily this has worked in terms of workflow impact."
The Results
Six weeks in, Develop Health pulls the patient's chart notes, fills out the forms, and makes the benefit verification calls. Kenny reviews each case in about two minutes, which used to be how long CoverMyMeds took just to load. Across the practice, the platform saves 20 to 30 hours of prior auth time every week.
Turnaround dropped from weeks to two days, and patients noticed.
"We're actually spoiling our patients and providers. Now they're like, 'it's been three days, why don't we have an answer?' And I'm like, do you remember how this was nine months ago? You waited a month."
Approval rates are climbing, and the staff who used to get buried in prior auth work, the medical assistants, the front desk, and Kenny himself, have that time back for patients. A full-time technician the practice had been planning to bring on turned out to be unnecessary, so the $40-50K set aside for that role is going toward patient care and other clinic priorities instead.
"We were gonna spend a full FTE technician. So the value to us is somewhere around $40,000 to $50,000 that I no longer need to spend. And that's with about 30 providers."
Better Than Expected
Kenny had planned to roll Develop Health out across a team, expecting he'd need the help. He hasn't had to. One pharmacy student helps out, and he handles the rest himself.
"My original plan was to roll it out because I was so overwhelmed. We've been able to manage it without that. It honestly worked out better than I expected and I was hoping for a lot."
What Happens Next
Kenny is already pointing peers to the product. He's told a nearby health system that runs 12 full-time technicians on prior authorizations to look into it, and a Massachusetts ACO group is lining up to roll it out across its Athena providers. His own pitch is blunt:
