In May, Congress reintroduced a bill that would streamline the prior authorization process for Medicare Advantage (MA) plans. Currently under review by the House, this legislation, if enacted, would set a precedent for all payers and plans. As such, SamaCare will be examining the issues addressed by this bill, using our experience and data working with practices that frequently prescribe physician-administered medications requiring prior authorization to shed additional light on these matters.
The Improving Seniors’ Timely Access to Care Act of 2021 addresses the following topics related to prior authorization, requiring MA plans to:
In this post, we will be examining the impact of electronic prior authorizations (ePA) on streamlining the prior authorization process for providers, and improving patients’ timely access to care. There is broad consensus in the healthcare community that electronic prior authorizations are preferable to offline prior authorizations. America’s Health Insurance Plans (AHIP) even published a study conducted in 2020 showing ePAs reduced the time between submitting a prior authorization request and receiving a decision from the health plan by 69%.
As a platform that helps providers submit, track, and manage prior authorizations across all payers, plans, and products for retina and oncology specialty medication, SamaCare has significant data on the differences between ePAs and manual PAs. Like the AHA study, our data shows ePAs, on average, receive a decision faster than manual PAs: ePAs received a decision 19.3% faster than manual prior authorizations. Looking only at approved PAs, this delta drops to 17.7%.
However, the story is more nuanced. Most (~75%) of prior authorizations are approved within one day. For the 25% of “wayward prior authorizations” not approved within one day, that number shoots up to 9.5 days. We found that out of all approved PAs, manual PAs were 11% more likely to fall into the category of “wayward” prior authorizations that take on average 9.5 days to approve.
Finally, to truly understand the impact of prior authorizations on patient care, we examined approval rate prior to intended date of service. This metric speaks to whether or not prior authorization approval delays a patient’s treatment plan -- resulting in rescheduled appointments, and increased patient anxiety. We found that, on average, manual PAs were 23% more likely to be approved after the initial intended date of service compared to PAs. That means 23% more patients who would need to be rescheduled, with a risk of their health deteriorating or abandoning the treatment altogether in the meantime.
Based on our data, electronic prior authorizations are therefore crucial to optimizing patient care. Stay tuned for our next blog post on the Improving Seniors’ Timely Access to Care Act of 2021, which will examine the provision of annual reporting on prior authorization benchmarks.
In May, Congress reintroduced a bill that would streamline the prior authorization process for Medicare Advantage (MA) plans. Currently under review by the House, this legislation, if enacted, would set a precedent for all payers and plans. As such, SamaCare will be examining the issues addressed by this bill, using our experience and data working with practices that frequently prescribe physician-administered medications requiring prior authorization to shed additional light on these matters.
The Improving Seniors’ Timely Access to Care Act of 2021 addresses the following topics related to prior authorization, requiring MA plans to:
In this post, we will be examining the impact of electronic prior authorizations (ePA) on streamlining the prior authorization process for providers, and improving patients’ timely access to care. There is broad consensus in the healthcare community that electronic prior authorizations are preferable to offline prior authorizations. America’s Health Insurance Plans (AHIP) even published a study conducted in 2020 showing ePAs reduced the time between submitting a prior authorization request and receiving a decision from the health plan by 69%.
As a platform that helps providers submit, track, and manage prior authorizations across all payers, plans, and products for retina and oncology specialty medication, SamaCare has significant data on the differences between ePAs and manual PAs. Like the AHA study, our data shows ePAs, on average, receive a decision faster than manual PAs: ePAs received a decision 19.3% faster than manual prior authorizations. Looking only at approved PAs, this delta drops to 17.7%.
However, the story is more nuanced. Most (~75%) of prior authorizations are approved within one day. For the 25% of “wayward prior authorizations” not approved within one day, that number shoots up to 9.5 days. We found that out of all approved PAs, manual PAs were 11% more likely to fall into the category of “wayward” prior authorizations that take on average 9.5 days to approve.
Finally, to truly understand the impact of prior authorizations on patient care, we examined approval rate prior to intended date of service. This metric speaks to whether or not prior authorization approval delays a patient’s treatment plan -- resulting in rescheduled appointments, and increased patient anxiety. We found that, on average, manual PAs were 23% more likely to be approved after the initial intended date of service compared to PAs. That means 23% more patients who would need to be rescheduled, with a risk of their health deteriorating or abandoning the treatment altogether in the meantime.
Based on our data, electronic prior authorizations are therefore crucial to optimizing patient care. Stay tuned for our next blog post on the Improving Seniors’ Timely Access to Care Act of 2021, which will examine the provision of annual reporting on prior authorization benchmarks.
In May, Congress reintroduced a bill that would streamline the prior authorization process for Medicare Advantage (MA) plans. Currently under review by the House, this legislation, if enacted, would set a precedent for all payers and plans. As such, SamaCare will be examining the issues addressed by this bill, using our experience and data working with practices that frequently prescribe physician-administered medications requiring prior authorization to shed additional light on these matters.
The Improving Seniors’ Timely Access to Care Act of 2021 addresses the following topics related to prior authorization, requiring MA plans to:
In this post, we will be examining the impact of electronic prior authorizations (ePA) on streamlining the prior authorization process for providers, and improving patients’ timely access to care. There is broad consensus in the healthcare community that electronic prior authorizations are preferable to offline prior authorizations. America’s Health Insurance Plans (AHIP) even published a study conducted in 2020 showing ePAs reduced the time between submitting a prior authorization request and receiving a decision from the health plan by 69%.
As a platform that helps providers submit, track, and manage prior authorizations across all payers, plans, and products for retina and oncology specialty medication, SamaCare has significant data on the differences between ePAs and manual PAs. Like the AHA study, our data shows ePAs, on average, receive a decision faster than manual PAs: ePAs received a decision 19.3% faster than manual prior authorizations. Looking only at approved PAs, this delta drops to 17.7%.
However, the story is more nuanced. Most (~75%) of prior authorizations are approved within one day. For the 25% of “wayward prior authorizations” not approved within one day, that number shoots up to 9.5 days. We found that out of all approved PAs, manual PAs were 11% more likely to fall into the category of “wayward” prior authorizations that take on average 9.5 days to approve.
Finally, to truly understand the impact of prior authorizations on patient care, we examined approval rate prior to intended date of service. This metric speaks to whether or not prior authorization approval delays a patient’s treatment plan -- resulting in rescheduled appointments, and increased patient anxiety. We found that, on average, manual PAs were 23% more likely to be approved after the initial intended date of service compared to PAs. That means 23% more patients who would need to be rescheduled, with a risk of their health deteriorating or abandoning the treatment altogether in the meantime.
Based on our data, electronic prior authorizations are therefore crucial to optimizing patient care. Stay tuned for our next blog post on the Improving Seniors’ Timely Access to Care Act of 2021, which will examine the provision of annual reporting on prior authorization benchmarks.
In May, Congress reintroduced a bill that would streamline the prior authorization process for Medicare Advantage (MA) plans. Currently under review by the House, this legislation, if enacted, would set a precedent for all payers and plans. As such, SamaCare will be examining the issues addressed by this bill, using our experience and data working with practices that frequently prescribe physician-administered medications requiring prior authorization to shed additional light on these matters.
The Improving Seniors’ Timely Access to Care Act of 2021 addresses the following topics related to prior authorization, requiring MA plans to:
In this post, we will be examining the impact of electronic prior authorizations (ePA) on streamlining the prior authorization process for providers, and improving patients’ timely access to care. There is broad consensus in the healthcare community that electronic prior authorizations are preferable to offline prior authorizations. America’s Health Insurance Plans (AHIP) even published a study conducted in 2020 showing ePAs reduced the time between submitting a prior authorization request and receiving a decision from the health plan by 69%.
As a platform that helps providers submit, track, and manage prior authorizations across all payers, plans, and products for retina and oncology specialty medication, SamaCare has significant data on the differences between ePAs and manual PAs. Like the AHA study, our data shows ePAs, on average, receive a decision faster than manual PAs: ePAs received a decision 19.3% faster than manual prior authorizations. Looking only at approved PAs, this delta drops to 17.7%.
However, the story is more nuanced. Most (~75%) of prior authorizations are approved within one day. For the 25% of “wayward prior authorizations” not approved within one day, that number shoots up to 9.5 days. We found that out of all approved PAs, manual PAs were 11% more likely to fall into the category of “wayward” prior authorizations that take on average 9.5 days to approve.
Finally, to truly understand the impact of prior authorizations on patient care, we examined approval rate prior to intended date of service. This metric speaks to whether or not prior authorization approval delays a patient’s treatment plan -- resulting in rescheduled appointments, and increased patient anxiety. We found that, on average, manual PAs were 23% more likely to be approved after the initial intended date of service compared to PAs. That means 23% more patients who would need to be rescheduled, with a risk of their health deteriorating or abandoning the treatment altogether in the meantime.
Based on our data, electronic prior authorizations are therefore crucial to optimizing patient care. Stay tuned for our next blog post on the Improving Seniors’ Timely Access to Care Act of 2021, which will examine the provision of annual reporting on prior authorization benchmarks.
