JACKSONVILLE, Fla., May 6, 2019 /PRNewswire-PRWeb/ -- Point-of-Care Partners, a health IT management consulting firm,
One of the main drivers of PA is the rising use of expensive and complex specialty medications. Although only one percent of prescriptions are for specialty drugs, they account for 1/3 (rising to ˝) of pharmacy plan costs, and many require a PA. These PAs are often completed via phone calls and faxes between the pharmacy, provider, and health plan. Manual processing is a time-consuming effort that leads to high administrative costs, the patient abandoning the prescription 37 percent of the time, and an increased time-to-therapy. Providers have been organized and vocal in their pushback against PAs, and in how ePA could help. Payers are starting to recognize the major investments they will need to make to address these concerns.
ePA is a major approach automating the PA process, thereby easing the burden of PAs and reigning in administrative costs while reducing time-to-therapy for patients from days/weeks to a few minutes. The most common adoption of ePA today takes place with drugs retrospectively, at the pharmacy. Prospective ePA, which would reduce costs and time to therapy even further, takes place at the time of ordering, but adoption has been disappointing for many reasons. Requirements for ePA that would apply to any treatment include accurate data that identifies if a PA is required, whether the treatment is covered by the pharmacy or the medical benefit, and the transparent and complete requirements for what information is needed based on history, evidence, and care plans to resolve the request. Transaction standards, interoperability technology for exchanging data, and workflow integration with EHRs and payer systems are among the most important areas for ePA advance, but each of these areas is a challenge.
To address these and many other ePA challenges, this report leverages Point-of-Care Partner's unique perspective and relationship in the market with payers, providers, and their vendors. POCP's experts drew on their extensive experience with ePA, ePrescribing, medication management, and transactions in support of value-based care together with industry interviews to craft this compelling report with a focus on:
"Prior authorization, while a powerful tool to achieve the goals of improving patient safety and containing costs, often comes with unintended consequences like administrative burdens for payers and providers in addition to drastically extending the time a patient has to wait for approval in order to start physician-prescribed therapy," said Ken Kleinberg, Practice Lead, Innovative Technologies, Point-of-Care Partners. "ePA is a key approach to ameliorating some of these unintended consequences through automation. Our goal with this report -- our most extensive ever (with 40+ diagrams and tables, and 90+ references) -- is to offer healthcare stakeholders an independent analysis of the market, realistic maturity models, and a profile of what vendors and service companies are currently doing around ePA so they can arm themselves with the information needed to plan strategically and meet their goals."
Payers, providers, life science companies, and vendors interested in learning more are invited to register for an informational webinar that will be held on May 29, 2019 at noon. For more information about the report, please visit our website. For direct inquiries about the report contact Ken Kleinberg ken.kleinberg(at)pocp(dot)com.
About Point-of-Care Partners Point-of-Care Partners is a health IT management consulting firm. Having been at the forefront of ePA for more than a decade, the firm's consultants have led NCPDP's Prior Authorization Workflow-to-Transactions Task Group since 2005; led efforts to create processes around the HIPAA-named standard for ePA, the X12N 278; is program managing efforts to leverage HL7's FHIR in support of ePA, and has advised the Federal government on ways to enhance adoption of ePA. To learn more about Point-of-Care Partners' ePA expertise, visit its website at http://www.pocp.com. If you're interested in POCP helping your company understand the changing healthcare landscape and implement effective ePA or medication management strategies, contact info(at)pocp(dot)com.
Related Links: HIT Perspectives Newsletter POCP Blog
SOURCE Point-of-Care Partners
Subscribe to our Free Newsletters!