In the healthcare landscape, value-based care represents a paradigm shift, designed to improve outcomes and increase patient satisfaction while controlling costs. This model’s fundamental premise reimburses providers based on quality of care, rather than volume. The shift from 'sick care' to 'health care' offers a more proactive, holistic, and patient-centric approach. What will play a role in a successful transition from fee-for-service to value-based care? Everything from preventive screenings to adoption of robust health technologies like prior authorization software. Let’s dive deeper into the topic. 5 key pieces of the value-based care puzzle Moving away from traditional fee-for-service healthcare delivery… Read entire article here
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
