Prior Authorization: Concept vs Execution To contain costs, health insurers and laboratory benefit managers (LBMs) rely on utilization management to introduce checks and balances that assess the appropriateness of a prescribed care regimen before authorizing it. The thinking behind this being that a less expensive option may be sufficient and that a stepped approach to patient care makes more financial sense than simply defaulting to the most expensive option. To make utilization management work, payers and LBMs increasingly require providers to obtain prior authorization, a preemptive check to gauge the medical necessity and cost ramifications of a prescribed treatment and… Read entire article here
Prior authorizations were created, in theory, to reduce the amount of unnecessary or redundant medical treatments, and therefore cut costs and improve patient safety. But in practice, the benefits of prior authorizations have only served to increase the cost for providers. Mention prior authorizations in a room full of physicians and you’re likely to see a fairly animated reaction. According to the Journal of the American Board of Family Medicine, prior authorizations cost the healthcare industry between $23 and $31 Billion each year and the American Medical Association found that the only other measure that physicians rated lower was patient cost… Read entire article here
April 20, 2022
Myndshft Expands Executive Team to Propel the Growth of Its Electronic Prior Authorization and Real-Time Benefits Check Technology
Justin Fugazy joins as Chief Revenue Officer and Kevin Dias as Chief Customer Officer to help lead the company’s continued expansion into the payer and acute care market. Mesa, AZ, April 20, 2022 -- Myndshft, a leading provider of real-time medical benefits check and electronic prior authorization technology, today announced the addition of two new executives to its leadership team: Justin Fugazy as Chief Revenue Officer and Kevin Dias as Chief Customer Officer. Fugazy will play a critical role in driving Myndshft’s sales and business development, while Dias will oversee the direction of Myndshft’s operations and client service teams, ensuring… Read entire article here
Lack of healthcare transparency. The tensions caused by prior authorizations. The tradeoffs between cost and care. These aren’t abstract concepts to Myndshft’s Director of Talent, Maria Montoya. Here is her story. “You’re too young to be here.” After trite introductions, those were the first words spoken by a silver-haired surgeon explaining the implications of my breast biopsy. Two months after my 30th birthday, flanked by my mother and husband, this man laid out the road ahead: first there would be surgery, likely not chemo, no radiation. It was still early, but nonetheless clear that I had breast cancer. I recall… Read entire article here
