High-Tech Solutions for Prior Authorization Problems

Nate Gosse, PhD
Published: Wednesday, Jun 07, 2017
Nate Gosse, PhD

Nate Gosse, PhD

Several provider challenges and opportunities were highlighted during the 2017 State Oncology Society Forum, hosted by the National Comprehensive Cancer Network (NCCN) at its annual conference, held in March in Orlando. Presenters and attendees discussed how the application of technology can drive significant near- and long-term benefits by easing prior authorizations (PAs), increasing information exchange, and balancing the roles between technology and human interaction in patient care.

Addressing the Challenges of Prior Authorization

PA requirements continue to increase as higher cost treatments, including oral and injectable therapies, are used in the treatment of cancer. Although payers initially developed the process to verify that a treatment is appropriate for a specific patient’s condition before the start of therapy, recent trends have led many providers to conclude that PAs are primarily a subterfuge intended to reduce costs and risk for payers; they have little regard for provider challenges or the burdens they place on patients.

When choosing technology, a practice should find a solution that offers point-of-care access to the library of NCCN Guidelines—the most widely recognized clinical treatment recommendations in oncology. From their technology, providers should also expect narrower clinical pathways, visibility into treatment cost, and the ability to highlight payer-specific preferences (or coverage) for patients. The ability to directly transmit required information for PA submissions and to provide real-time reporting and physician feedback will ensure that the challenges of PA can be minimized. This will enable physicians to focus on practicing medicine, not negotiating with payers.

Sharing Information Between Systems

In the consumer world, we quickly become irritated if we are repeatedly asked to provide the same information to complete a transaction. Yet in healthcare, we are only now moving to an era in which the same information or data can be repurposed to complete multiple tasks.
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