Apr 11th 2018

AMA Survey Shows Need for eviCore’s Prior Authorization Improvements

As a family-practice physician of more than 30 years, I know the frustrations prior authorization can cause. Almost everyone involved in healthcare can agree there are plenty of opportunities for improvement, and a recent physician survey by the American Medical Association (AMA) shows why.

About 84 percent of physicians surveyed said they believe the burdens associated with prior authorization are high or extremely high, and a similar number (86 percent) believe those burdens have increased during the past five years.

There are a few provisos to note in this survey's findings, but the most important thing eviCore would like providers to know is that we hear you. As a physician who has been in your shoes, I know that the prior authorization process can be very frustrating. That's why we're listening to you to better understand your concerns and suggestions on how we can continuously improve our process. Our goal is a genuine partnership that helps us all serve patients better.

That said, this survey consisted of self-reported data, and although dissatisfaction with these types of processes certainly exists, the need for prior authorization—to rein in inappropriate, potentially unsafe care and unnecessary costs—is still vital. As research published in the Journal of the American Medical Association (JAMA) in 2012 found, overtreatment accounts for between $158 billion and $226 billion in wasteful healthcare spending in the U.S. And that doesn't account for the patient harm it causes, which some experts estimate results in 30,000 deaths in the U.S. each year. That's on par with the number of people we lose to fatal car crashes annually.  Doctors estimate that 21 percent of medical care is unnecessary, according to a survey published in September 2017 in the scientific journal PLOS ONE, and numerous studies have confirmed serious challenges posed by inappropriate treatment across disciplines.

So, with the clear need to make sure that patients get evidence-based care, eviCore has taken critical steps—both immediate and long-term—to mitigate as many pain points as possible. We offer an industry-leading combination of high-touch services and advanced technology to automate more processes and get decisions to you faster.

To improve your interactions with us, eviCore has established a dedicated Provider Experience team comprised of clinical practice, operations, and communications experts. We also heard your concerns about web portals, and have recently deployed sophisticated technology to make ours easier to navigate. For example, we now automatically connect you to the appropriate portal when you're logging in, and we've reduced the number of questions required. In addition, we've made the clinical guidelines easier to locate by adding a direct link at the top of the page. In 2017, about 94 percent of cases were approved within one business day, and 99 percent were determined within three. More enhancements to our website will be announced and implemented later this year.

We've also made changes to the peer-to-peer process based on your feedback. Now you can use our website to schedule appointments for these discussions when they will be most convenient for you. And when you speak with a peer to review a case, we make sure to match you with a clinician in the same specialty.

As for longer term, more "game changing" improvements, we're leading the market and implementing an automated, electronic prior authorization solution that streamlines the case submission and review process. It's integrated with EMRs, so it pulls the necessary data for a decision directly from the electronic health record, creating the potential for immediate authorizations when an order is placed. Our solution will also share the latest evidence-based, appropriate clinical guidelines at the point of care, so providers can make swift decisions about the best course of action in advance of seeking pre-approval.

Ultimately our evidence-based clinical guidelines, which are fully transparent and available on our website, are intended to support sound medical judgment, not supersede it. Our efforts are also intended to help you deliver appropriate care without slowing it down—as those statistics I cited on our 2017 rates of approval demonstrate.

But we know we can keep improving the process. We want to work in partnership with providers to ensure your patients receive high-quality, medically appropriate care when and where they need it. One way to do that is to continue to listen to your feedback about our process. We encourage you to email me at: onlineinfo@evicore.com.  We very much appreciate your suggestions for making it better.

Gregg P. Allen, M.D. FAAFP
Chief Medical Officer
eviCore healthcare