Improving Access Strategy Through Real-World Coordinator Insights
A healthcare client sought to better understand the root causes behind delays and denials in the approval process for advanced specialty therapies. Despite overall high approval rates, frontline teams were experiencing workflow inefficiencies, extended timelines, and inconsistent payer expectations, all of which slowed patient starts and burdened staff. The client partnered with KS&R to identify practical opportunities to streamline access through the lens of those managing authorizations every day.
KS&R conducted a multi-wave quantitative study with experienced authorization coordinators across outpatient practices and infusion centers. Participants submitted recent prior authorization (PA) cases, providing detail on timelines, insurer communications, benefit channels, and documentation challenges. In parallel, respondents shared qualitative context around real-world barriers and workarounds, allowing the client to assess not only what was happening, but why.
The analysis examined differences by clinical setting, payer type (commercial vs. government), and submission strategy, highlighting both friction points and success factors.
The study revealed that while approval rates were strong, PAs submitted under the medical benefit required more follow-up and processing time than those under the pharmacy benefit. Coordinators also identified that submitting more complete or strategically timed requests, such as including full treatment cycles, often led to faster, first-time approvals.
These findings enabled the client to refine their provider support tools, align messaging with actual coordinator needs, and streamline submission guidance across their portfolio. Ultimately, the work helped reduce administrative friction and support more timely patient access, strengthening relationships with both payers and provider offices.
