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The electronic prior authorization tipping point

Today’s prior authorization (PA) process for certain high-cost medications is often a lengthy, manual back-and-forth process among the doctor, payer, pharmacy and patient. But times are changing, and about 20 states have legislation proposed or in place to improve the process with electronic prior authorizations (ePA).

The industry is at a tipping point and ready for change. Health IT partnerships with payers and life sciences companies can enable physicians to obtain PA electronically, leading to faster patient access to medications and reduced rates of prescription abandonment.

Manual prior authorizations aren’t working

According to Frost and Sullivan, about 70% of patients who encounter a manual, paper-based PA do not receive the original prescription, and patients abandon about 40% of manual PAs. With 180 million PAs each year, we can estimate that about 72 million prescriptions are abandoned each year.

Manual PA processes are also a time drain for healthcare staff. The average time to complete the approval process is about 15 minutes, though it can take several days or an entire week to fully resolve an authorization.

Physician practice saves up to 3 hours per day with Allscripts eAuthTM

For North Country Family Practice (Southlake, Texas, U.S.A.), eAuth* solved many of the challenges of the manual PA process. “The manual prior authorization process was pure chaos,” Nurse Manager Shelley Wallis said. “The formularies weren’t always accurate, we had to handwrite forms and fax them in, there were multiple patient calls and pharmacy calls…it took so long and hardly ever went smoothly.”

When Wallis learned about the capabilities of eAuth, including the fact that physicians can complete the ePA with their Allscripts electronic health record (EHR) workflow, she was “ecstatic.” Because physicians are doing the ePAs, instead of other staff members, they can provide the rationale for that particular medication and avoid extensive rounds of phone tag among patients, providers and pharmacies.

The solution instantly gives prescribers access to preferred formularies for insurance plans, and gives alternatives that may not require PA. Wallis reports that this step has reduced the number of PAs by almost half for the practice. For the PAs that are required, Wallis estimates the turnaround takes an hour or two most times, compared with a process that could take days or weeks.

Wallis noted that providers were initially concerned about the additional demands on their time to complete the PA process themselves. But when they saw how easy the process is, and how it ultimately saves time for the practice, it became a non-issue.

“eAuth lifts a heavy burden from staff, because they’re not focused on this paperwork anymore,” Wallis said. “It’s freeing up staff to reach out to patients who have chronic diseases or are at risk for these conditions…staff can better use their knowledge to help improve outcomes and potentially realize more revenue through our Medicare ACO [Accountable Care Organization].”

Wallis continued, “eAuth helps us do the right thing for the patient…they’re not waiting for these prescriptions and our staff now has more time to provide the quality care they need.”

This solution illustrates the importance of bringing together all stakeholders—providers, payers, health IT, patients – to effect change in health care. Together we can answer the call for more efficient and effective care delivery throughout the continuum. Learn more about eAuth here.

 

* This solution is currently available for both Allscripts TouchWorks® EHR and Allscripts Professional EHRTM.

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About the author

Faisal Mushtaq is President of Allscripts Payer Life Sciences business. This business focuses on generating immediate value for providers and patients by leveraging Allscripts data and clinical, adherence and education messaging infrastructure to enable improved clinical outcomes at a lower cost. Faisal leads a team of cross-functional professionals skilled in field sales, product management, and client support and implementation services. He also oversees the PayerPath business. Faisal has been in the healthcare IT industry since 2000 and has extensive entrepreneurial business experience. He has led teams of all sizes, spanning many organizational areas including Portfolio Strategy, Sales, Business Development, Technology, Operations and Software Development. Before Allscripts, Faisal served in several leadership roles at Misys, which was acquired by Allscripts in 2008. Following the acquisition, Faisal served in various executive leadership roles in the Solutions Development organization of Allscripts, including the leader of Solutions Management for the ambulatory market and the leader of Portfolio Management. Faisal is a member of the Board of Directors at the Council for Entrepreneurial Development, an organization that helps entrepreneurs grow their business by connecting them to the network, knowledge and capital needed to start their company. Faisal earned a Bachelor of Science degree in Computer Science and Computer Engineering from the University of Wisconsin-Madison. He has also completed Advanced Management Program at Harvard Business School.

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