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I’ve always wanted to visit Austin, so when Surescripts asked me to travel to a clinic there for a month, I said yes and flew from my home in Miami Beach on a mission: see how Electronic Prior Authorization works in the real world. Here’s my “diary” on the experience.
Project: A 30-day research study with Senior Business Analyst Skarlett Salazar (and other Surescripts colleagues) to observe providers and medical assistants as they conduct prior authorizations for prescriptions.
Goal: To better understand the prior authorization process and pain points, and to apply the benefits of Electronic Prior Authorization—workflow efficiency, speedier time to therapy, medication adherence—to more clinicians and their patients.
Outcome: The number of Electronic Prior Authorization requests submitted by clinicians in May, the month after my visit, jumped by about 37%.
The outcome described above speaks to the power of awareness, understanding and thoughtful design when it comes to adopting and using new health IT tools in the clinical setting, as Surescripts Director of Product Marketing, Terry Douglas, told me.
I saw this most clearly on April 28—my last full day in Austin—when I worked with a doctor on a hung-up prior authorization.* I took him through how to process the prior authorization electronically with Surescripts, and we received immediate approval right then and there.
“Oh!” he said. “That’s it?”
“That’s it,” I replied.
*Of course, handling protected health information (PHI) is not something we take lightly, and it’s not every day that we work inside our customers’ EHRs. This was a special case, where I was authorized to use the eMDs EHR while I was on-site at the clinic. You can visit our website to learn more about our commitment to network integrity.
Engaged partners help make the network stronger! Dr. Eric Weidmann introduced me to the product owner of his clinic’s CGM eMDs integration—their electronic health record (EHR)—so we can collaborate and share ideas throughout April.
Feeling like a detective today (and feeling a bit like Surescripts Senior Network Access Analyst Claire Leduc in the art of a data detective). I’m digging into the data to understand why some prior authorizations sail through with no issues, while others get hung up for days or even weeks.
The challenge is what you’d call “multifactorial,” but this challenge is exactly what Electronic Prior Authorization was made to solve.
It's Good Friday. This meant a slower day. I worked on getting metrics around prior authorizations at the clinic, so we can see a "before" and "after" snapshot of how many prior authorizations are completed through Surescripts. Pictured here is our workspace for the day.
A slow Monday, but valuable, because Surescripts Product Analyst Larissa Lipani from our Eligibility & Formulary team is onsite. We had a half hour with Dr. Weidmann to view the prescriber workflow and pick his brain.
Dr. Weidmann shared his view that prior authorizations can influence physician behavior in terms of prescribing decisions. And he said that having a hearty list of medication alternatives—which don’t require prior authorization in the first place and may be more affordable—can make all the difference.
As Larissa pointed out, the point about medication alternatives resonated with her, because this is how our Eligibility & Formulary solution—at the plan level—and our Real-Time Prescription Benefit solution—at the patient-specific level—can work well together.
Staff had their monthly meeting today, so the clinic closed from 11:30–2:00, and I had the opportunity to share more widely with the providers and medical assistants what we're doing, how I'd like to help them, and how I'd like them to help me, like sending me their prior authorizations and showing me their workflow.
This is my first onsite ever, and it’s awesome seeing Electronic Prior Authorization in person. I’m what you’d call a “subject matter expert” when it comes to Electronic Prior Authorization—but that’s in terms of XML transactions and business rules. Seeing Electronic Prior Authorization in action for myself is a whole new ballgame.
I'm getting more comfortable with the workflows, and I think the people who work at the clinic are getting more comfortable sending me their prior authorizations—especially when many prior authorizations only take a minute or two for a response!
I’m working with Surescripts Informatics Clinician Donna Hayes to organize my findings, discern patterns, and identify areas that need more research.
This is my last week here! And I've got plenty of visitors, including two people from my team and a couple folks from the Eligibility & Formulary team.
I called a pharmacy benefit manager (PBM) about a prior authorization that had been denied and sat on hold for 45 minutes before giving up. I’ll try again tomorrow and hope to have better luck, but this experience is just one more reason to use Electronic Prior Authorization.
I can’t help but think about providers on hold like this across the nation—even if the average hold time was just five minutes—and how much that adds up both in costs and in time taken away from actual patient care.
Today was a team lunch with my manager, Emelie Jensen, and Senior Product Analyst Brent Bangsund from the Eligibility & Formulary team. The Austin food scene comes in at a close second to all I’m learning here.
Kind of funny, but as Surescripts employees, we usually observe how hospital or clinic staff—not ourselves—work inside EHRs. By this point, though, I’ve been working in the eMDs EHR with prior authorizations so long that my Surescripts colleagues told me: “It’s wild how you’re not really observing, but just handling things yourself!” And: “Wow, you really have a hang of this EHR.”
The patient was waiting for his prescription, and the doctor was waiting on the prior authorization. So, I walked the doctor through how to do the prior authorization electronically through Surescripts. We received the question set right away, the doctor answered it right there, and we got immediate approval! This was such a win for both of us—and for the patient, too.
What an amazing experience!
The people at the South Austin Medical Clinic were so friendly and helpful with teaching me the ropes the first week or two. And I appreciated their cooperation and willingness to go out of their way to bring me their prior authorization questions.
And it was funny to see personalities shine through in how they reacted to me being there. Some folks were more than happy to bring me their prior authorizations on the very first day. Others, not so much.
With Electronic Prior Authorization—together with Eligibility & Formulary and Real-Time Prescription Benefit—providers can choose a different drug to avoid prior authorization. Or they can at least know ahead of time if the medication will be covered or not and could perhaps skip the prior authorization altogether.
Electronic Prior Authorization makes a very big impact on people’s lives, from prescribers to pharmacists to patients.
I’m glad I had the opportunity to do this.
Until recently, prescribers and pharmacists have lacked tools to efficiently find prescription options that they’re confident patients can access, afford and adhere to. Prior authorization follow-up and pricing research, for example, takes providers hours every week.
Get prescriptions filled faster with prior authorization insights, question sets and responses to help manage prospective and retrospective requests swiftly. Get Electronic Prior Authorization.
Dean Riggott Photography
Surescripts
