September 27, 2023
Tackling the PBM Dilemma: Is Automated Pharma Prior Auth the Answer to Healthcare Complexity?
by Susan Lawson-Dawson | Healthcare Technology
Last year, the Federal Trade Commission (FTC) announced an investigation into the business practices of Pharmacy Benefit Managers (PBMs), beginning with the six largest ones in the U.S. This year, the U.S. The House Oversight and Accountability Committee launched its own inquiry into PBMs. Why are they under so much scrutiny? While PBMs get described as integral to the U.S. healthcare landscape, a growing number of healthcare stakeholders are raising critical questions about added complexity, higher costs, and patient impact. Let’s explore the factors leading many to reevaluate the role PBMs play in our healthcare system and how pharma prior… Read entire article here
You can’t talk about transforming healthcare in the US without talking about prior authorization. There. We said it. Of course, we aren’t alone. Politicians, providers, payers and patients all recognize problems with prior authorization. It’s not surprising, then, that intelligent prior authorization earned a spot on the GartnerⓇ Hype Cycle for Healthcare Payers in 2023. How does intelligent prior authorization differ from the status quo? Currently, the typical prior authorization process is manual or a clunky combination of manual and electronic steps that acts as a bottleneck in patients’ care journeys. By using natural language processing, artificial intelligence, and HL7Ⓡ… Read entire article here
In the dynamic landscape of healthcare, inefficiencies cost everyone time and money. When it comes to prior authorization, those shortcomings contribute to friction between payers like you and your networks of healthcare providers and members. In an Op-Ed in Becker’s Hospital Review, Northwell Health President & CEO Michael J. Dowling wrote, “To sustain our delivery system, the future of healthcare must include productive partnerships between providers and payers. Without increased cooperation, we'll continue to be adversaries and everyone, including patients, will suffer.” As with Goldilocks and the Three Bears, the key to success lies in finding the “just right” balance… Read entire article here
In the ever-evolving landscape of healthcare, the shift from fee-for-service to value-based care is a pivotal transformation that has the industry buzzing. This change prioritizes patient outcomes over volume, aiming to ensure high-quality healthcare at a reduced cost. However, this paradigm shift doesn't come without its set of challenges, particularly concerning cost management. Prior authorization software automates a notoriously time-consuming process, helping you reduce operational costs while connecting patients to the care they need. Value-based care: A multi-pronged challenge Under the value-based care model, healthcare providers payments are tied to patient health outcomes. The focus shifts from the quantity of… Read entire article here
