Dr. Dipak Nandi: Surefire Tips for a Better Prior Authorization Strategy

Non adherence to medication is costing the US healthcare approximately $290 to $300 billion every year. Patients expect care to be provided to them with complete convenience and ease. However, physicians being unaware of the fact if a particular medication process is covered by the insurance, the process has to wait.

An electronic prior authorization solution increases quality and decreases the turnaround time for everyone involved – patients, physicians, the health plans as well as the PBM’s.

A small reduction definitely is not going to solve the problem. We have to make the best use of the available technology interfaces that complete prior authorization process in minutes rather than days or hours. It will be a big win particularly for the patents that are more likely to adhere to the plans of medication in place.

Digitizing the Entire Provider/Pharmacy Workflow

Poor handwriting, data entry mistakes are pretty common in a manual process. Electronic prior authorization is a must road-map for the healthcare providers at present. Improvement in compliance, reduction in adverse events of drugs and generic utilization all elevates therapy adherence in best proportions.

  • Electronic prior authorization, in fact, is a more recent innovation. Significant IT developments in resources have invested majorly to support this vital connection.
  • It helps in closing the gaps in care so that the patients get the right dose and medication based on the right benefit plan.
  • A secure web portal helps in delivering healthier outcomes than the manual processes of prior authorization.
  • It enables provider success and improves care quality especially in a world that is value driven.

The rising costs of healthcare have piqued the attention of the payers for value-based models of care. Improving the interactions across the entire healthcare landscape is possible with these models that appear proactive.

Adoption of Electronic Prior Authorization has to spur

It is pertinent to educate the healthcare providers on all the benefits associated with electronic submission of prior authorization requests.

EMR’s that are still not enabled for electronic prior authorization need to build the right functionality in the IT space for a seamless share of information.

Ultimately, you will find the physicians to spend more time with patients and less of tedious paperwork. Automation in practice management can make this desire a definite reality!

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