In today’s landscape, both patients and healthcare providers face burnout as they navigate the persistent challenges of accessing therapy, creating frustration for both sides. The concept of Patient Support Services was developed to address these challenges, providing a critical layer of guidance, advocacy, and continuity.

Delivered by multidisciplinary teams with roles shaped by program design and complexity, Patient Support Teams are united by a shared purpose: to help patients navigate complexity and ensure a smooth, frictionless experience for healthcare providers when interacting with the support team. For this article, we will refer to these roles collectively as Care Coordinators.

Care Coordinators manage high call volumes, document detailed interactions, coordinate across stakeholders, and support patients during some of the most stressful points in their therapy journey. This work is essential, complex, and sustained over time. It raises an important question for the industry: how do we augment their work? How can we innovate to make their work easier, faster, and more impactful without compromising the human connection patients rely on?

Industry Challenges

In a 2023 survey conducted by the Medical Group Management Association (MGMA), 89.3% of group practices found prior authorizations (PAs) to be ‘very or extremely burdensome.’ The report stated that not only did utilization management tools like PAs delay patient care, they also increased provider cost and burden. The burden lies in submitting documentation manually, either by fax or directly through a health plan portal. This, compounded with changing requirements related to medical necessity and appeals, frequently leads to frustration.

One group practice cited in the report was quoted as saying, “We have 20 physicians ... and six full time prior authorization staff members…and it’s difficult to get ahead and obtain the PAs two weeks out.”

According to the Council for Affordable Quality Healthcare (CAQH), prior authorizations remain one of the functions with the lowest electronic adoption rates. So, while the new legislation will bring some relief, it won’t fully address the problem.

Knowing that this information will be more readily available, it is likely that practices will not want to take on the challenge of building and maintaining a system that connects them to this information. The most reasonable prediction we can make is that patient support teams will be busier than they were in 2025.

CMS Interoperability and Prior Authorization Final Rule (CMS-0057-F) will apply to:

• Medicare Advantage (MA) Organizations
• Medicaid Managed Care Plans
• State Medicaid and CHIP fee-for-service programs
• CHIP managed care entities
• Qualified Health Plan (QHP) issuers on the Federally Facilitated Exchange (ACA Marketplace).

The New Challenge

Care Coordinators already spend significant time on manual tasks like notetaking, call reviews, and trend analysis. These tasks, while essential, take away from what matters most: building trust and delivering personalized care. Increasing call volumes will only diminish the time they have to truly support patients.

Our Use Case

Valeris is building an AI-driven platform designed to augment human performance, not replace it. Here’s what it does:

100% Call Scoring with Instant Feedback
Every call is analyzed in real time, providing agents with immediate insights on what went well and what could improve. This turns every interaction into a learning opportunity.

Next Best Action Recommendations
Based on live call signals, the AI suggests proactive steps—whether it’s clarifying a medication schedule or offering emotional support—helping coordinators respond with confidence.

Automated Call Notes in Standardized Format
No more scrambling to capture details. The AI generates structured, accurate notes instantly, freeing up time for meaningful patient engagement.

Signal Detection for Trends
The system identifies recurring themes and unusual patterns across calls, enabling teams to address systemic issues before they escalate.

Customer-Driven Call Retrieval
Clients can easily request calls based on specific events or keywords, making quality assurance and compliance effortless.

Anticipated Impact

Faster Documentation: Coordinators reclaim hours each week.

Better Conversations: Real-time coaching improves empathy and clarity.

Smarter Decisions: Data-driven insights lead to proactive care.

Enhanced Compliance: Standardized notes and easy retrieval reduce risk.

Stronger Therapy Committment: Coordinated support encourages adherence.

Why It Matters

This is about amplifying care coordinators’ ability to care. By removing administrative burdens and providing actionable intelligence, Valeris empowers them to do what they do best: support patients with compassion and precision.

Our Anticipated Results

• Call scoring coverage will expand to 100% following development, enabling teams to deepen insights and strengthen actionable feedback across every interaction.

• Manual audits and call scoring (per program) that used to take 1-3 business days can now be completed in approximately four hours. A 75-80% gain in efficiency is expected.

• Average Handle Time for calls for care coordinators is approximately 7 to 12 minutes, not including time spent on hold. The time to take notes or document a call uses roughly a minute or two of that total time and happens during the call. A 25% gain in efficiency is expected.

Closing Thought

AI in healthcare isn’t just about technology, it’s about trust, empathy, and better outcomes. This is just the beginning of how we’re redefining patient support through human-AI collaboration.

Contributors

Ann Poorboy, MS, Senior Director, AI Product Lead

Sini Abraham, EVP, Client Services and Operations

Chip Kennedy, VP, Operations Excellence

References

“2024 CAQH Index®- From Transactions to Trust: Building Better Care Through Healthcare Automation,” Council for Affordable Quality Healthcare, Inc., 2024.

“CMS Interoperability and Prior Authorization Final Rule CMS-0057-F" Center for Medicare and Medicaid Services, January 2024.

“2023 Annual Regulatory Burden Report” Medical Group Management Association, November 2023.

“2021 CAQH Index®- Working Together: Advances in Automation During Unprecedented Times,” Council for Affordable Quality Healthcare, Inc., 2022.

“Advancing Interoperability and Improving Prior Authorization Processes Proposed Rule CMS-0057-P: Fact Sheet,” Centers for Medicare & Medicaid Services, December 2022.