While the intention behind prior authorization is to control costs and promote appropriate healthcare utilization, a mounting body of evidence shows that prior authorization disproportionately affects certain racial and socioeconomic groups, exacerbating existing healthcare disparities. Automating prior authorization helps reduce those barriers, but more work needs to be done. An article published in RollCall on World Cancer Day 2021 noted, “Disparities in clinical trials have been a concern for decades, but it’s generated more attention as the field of precision medicine has taken off. As targeted therapies become a reality—and as dozens of personalized medicines on the market help patients… Read entire article here
While there has been significant attention given to eliminating systemic biases and addressing social determinants of health in the national conversation, the ability to access healthcare can also be hindered by the utilization management (UM) processes. In particular, prior authorization, which necessitates approval from a payer before a member can receive medical treatment. Although it may seem logical to assume that this barrier affects all members equally, regardless of their race or socioeconomic status, the reality is that prior authorization disproportionately impacts predominantly impoverished, rural and minority communities. Automated prior authorization can help overcome disparities. Problem: Providers in underserved communities… Read entire article here
The American Cancer Society expects newly diagnosed cancer cases in 2023 to exceed 1.9 million—and that figure doesn’t even factor in skin cancers not subject to reporting. The good news: The cancer death rates have been on the decline. Between 1991 through 2020, the rate dropped by 33%, thanks in large part to early detection and treatment advances. What hasn’t declined is the volume of prior authorizations required. If anything, volume is higher than ever as payers try to control costs through utilization management. As a result, says Oncology Insights, 70% of oncologists report needing full-time staff to manage prior… Read entire article here
Staffing challenges and clinician well-being have emerged as critical concerns in the healthcare industry. While “mindfulness” is a popular coping mechanism for daily stressors, some problems are too big. Recently, Politico interviewed American Medical Association President Jack Resneck about a number of challenges in healthcare. Responding to a question about solving burnout he said, “You can’t yoga your way out of severe burnout because you’re spending hours a day doing prior authorization.” And therein lies the reason that a growing number of healthcare providers tackle this administrative burden with prior authorization software. Let’s delve into how this software offers much-needed… Read entire article here
