February 14, 2017

Electronic Prior Authorization Delivers the “Holy Grail” of Healthcare: Increased Patient Safety, Lower Costs and Higher Quality

When patients visit a doctor’s office or pharmacy, they want convenience. Consumers expect care to be delivered with ease and efficiency, so they can follow their providers’ recommendations with confidence. But when physicians don’t know if their patients’ medications will be covered by insurance or patients are forced to wait to fill prescriptions only to find out they can’t afford them, the process breaks down for everyone.

Monica Stegall, Director of Product Management at Express Scripts sat down with us to share her perspective on the importance of using an electronic prior authorization solution to increase the quality of healthcare.

1.  Medication non-adherence costs the U.S. healthcare system an estimated $290 to $300 billion each year. How does electronic prior authorization increase medication adherence?

Replacing existing fax and phone exchanges with an electronic exchange decreases the prior authorization turnaround time for everyone involved—physicians, patients, health plans and PBMs, including Express Scripts. And we’re not talking about small reductions in time, we’re talking about completing prior authorizations in minutes instead of hours or days. This is a huge win because patients are more likely to adhere to medication plans if they can get their meds quickly and easily.

2.  Why is digitizing the entire provider/pharmacy workflow so important for patient safety and what capabilities are “must-haves” today?

When healthcare is recorded and transmitted outside of an electronic environment, the risk of error from manual processes, such as poor handwriting or data entry mistakes, increases. Electronic prescribing is a must for physicians today. It results in measurable waste reduction through improved generic utilization and formulary compliance, as well as a reduction in adverse drug events, all while improving therapy adherence.

E-prescribing is usually done through electronic health records (EHRs), which include patient charts and a plethora of other data resources. These tools give prescribers access to a wealth of relevant, real-time patient information, including patient benefits eligibility, prescription histories, drug interactions and more. This data helps close gaps in care, so patients get the right medication at the right dose based on the right benefit plan.

Electronic prior authorizations are a more recent digital innovation. Over the past few years, significant IT development resources have been invested to support this vital connectivity. Whether prior authorizations are submitted through physicians’ EHRs or a secure web portal, they deliver more time-savings and healthier outcomes than manual prior authorizations.

3.  How can electronic prior authorization enable care quality and provider success in a value-driven world?

Due to rising healthcare costs, value-based care models have piqued the attention of insurers, health systems and physicians. They recognize the positive impact these models can have on patients and are proactively finding ways to improve interactions across the healthcare landscape.

As a PBM, Express Scripts supports more than 200 health system clients, including providers in value-based incentive programs. Our medication adherence programs and predictive analytics, in addition to our focus on optimizing pharmacy networks, all place a greater emphasis on value and outcomes.

Electronic prior authorization is another important solution for providers. Physicians can send 11 prior authorizations electronically in the time it takes to fax just one.1 In addition to the prescriber, authorized personnel such as nurses and office staff can use electronic prior authorization, which gives physicians more time to focus on patients.

4.  What needs to happen to spur the widespread adoption of electronic prior authorization among providers?

Many healthcare providers don’t know electronic prior authorization is available, so it’s crucial to educate them on its benefits and tell them how to get started. In addition, EHRs that are not enabled for electronic prior authorization need to build the IT functionality into their systems.

Ultimately, physicians want to spend more time with patients and less time on paperwork, and electronic prior authorization can help make that desire a reality.

Learn how Surescripts electronic prior authorization can address your prior authorization challenges today. If you are attending HIMSS17, visit Surescripts booth #6660 or our presentation at the Connected Health Experience (booth 7281) on Tuesday, February 21 at 1:30 p.m. ET to learn more about CompletEPA®. Be sure to follow the conversation on Twitter via the @Surescripts handle and #HIMSS17 hashtag.

1Information based on Comcast and Verizon broadband rates and fax speed of 33.6 kps.


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