The Fast PATH Program touts electronic prior authorization using health IT and EHRs as a key solution for utilization management.
A new program from America’s Health Insurance Plans (AHIP) aims to utilize EHRs and other health IT to streamline prior authorization, a process many in the healthcare industry say can hamper patient access to certain medications.
The Fast Prior Authorization Technology Highway (Fast PATH) initiative, recently launched by AHIP, puts technology front and center as more providers aim to make prior authorization a more workable utilization management strategy.
“When patients do better, we all do better. Patients should receive the right treatments and medications at the right time in the most effective and efficient way,” said Matt Eyles, president and CEO of AHIP. “That’s why we’re committed to reducing unnecessary burden, increasing patient satisfaction and improving quality and outcomes.”
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Prior authorization is a key utilization management strategy many healthcare payers use to ensure patients access the most clinically and cost-effective medication available to them. When a drug has prior authorization requirements, the provider must submit certain documents to a healthcare payer to receive permission before prescribing the drug.
Completing prior authorization can be arduous for providers and lead to delays in patient care access, with 46 percent of authorization requests being submitted by fax and 60 percent made over the telephone. However, electronic prior authorization is becoming more prevalent in the medical field.
Using Availity and Surescripts technology, Fast PATH will be utilized through EHRs and improve the relationships between insurance providers, doctors’ offices, and other care settings.
The initiative will improve prior authorization for prescription medications by being available immediately to both the clinician and the patient. It will cover the prescribing process, reduce surprises that the patient might typically face at the pharmacy counter, and make the overall experience run more smoothly for both the patient and the clinician.
With the Fast PATH program and Surescripts technology, the physician can access the patient’s benefits, check and see more cost-effective options that do not require prior authorization, and know whether the specific medication requires prior authorization prior to prescribing. If prior authorization is necessary, then the physician can submit the request through the EHR. The physician may also utilize a price transparency tool that keeps the patient informed.
This project also aims to improve prior authorization for both medical and surgical procedures.
Specifically, a provider will received a notification immediately if the procedure requires prior authorization based on the patient’s health insurance. If prior authorization is needed, then the user can utilize the multi-payer portal to make the request. The health provider then can review the request and send a response back through the portal.
AHIP has teamed up with RTI International to assess the improvements to the patient-provider experience and Point of Care Partners to as an advisor to the project.
“RTI is honored to serve as the independent evaluator to AHIP on a critical topic that affects patients and providers in support of higher quality and more efficient care delivery,” said Alex Cowell, PhD, engagement leader at RTI.
The goal of the Fast PATH initiative is to promote interoperability with existing EHR systems, AHIP said.
“The Fast PATH initiative is another example of health insurance providers, doctors, and health information technology vendors working together for the betterment of patient care,” concluded AHIP.
AHIP partnered with key healthcare payers that cover over 60 million individuals across the country including Anthem, Blue Shield of California, Cambia’s affiliated health plans, Cigna, Florida Blue, and WellCare.
Source: EHR Intelligence