How EHR Prior Authorization Can Help Your Health IT Clients Promote Medication Adherence

By Megan Williams, contributing writer

Connecting with your clients’ clinical concerns is a sure way to communicate that you understand their business on a practical level. One of the most pressing concerns for the care of the patients is medication adherence, an issue that costs the industry hundreds of billions of dollars a year, according to Health IT Analytics. Prior authorization is a key component of resolving that problem. It’s an issue that will become even more important to your clients as chronic disease management and positive patient outcomes become more directly connected to facility revenue.

The Importance Of Prior Authorization

According to David Yakimischak, executive vice president and general manager of medication network services at Surescripts, prior authorization of prescriptions happens about 2 to 4 percent of the time:

“That doesn’t sound like a lot, but when you take billions of prescriptions every year, there’s actually quite a bit of prior authorization work that has to go on. Basically, the prescription is sent to the pharmacy, and when the pharmacy goes to get payment from the insurance company and run the insurance claim, that they find out if they need to get prior authorization. And so it becomes a speed bump in the process. The pharmacy can’t dispense the medication to the patient, so they have to get back in touch with the physician. The physician has to contact the payer or pharmacy benefit manager (PBM); and it’s handled through phone calls, paper, and faxes. It takes several days, and we end up with a high abandonment rate where a number of patients just don’t wait for everything to get finished, and they never do get their medicines.”

Patients Falling Off, Epic Stepping In

Yakimischak cites statistics that show that, after 12 months, patient adherence rates drop to less than 50 percent — a huge problem when patients are taking medications that treat conditions like high blood pressure or diabetes.

Surescripts, having a long history in specializing in e-prescribing, partnered with Epic Systems this October, and announced they would be launching a simpler, integrated, electronic prior authorization (ePA) process into Epic’s EHR product as a solution to the pressing problem that current prescription workflows face. The move is expected to be imitated by other EHR vendors, so Surescripts is making an effort to stay neutral, and keep options open to other, smaller vendors.

Integration

The integration process is simple, and similar to methods used in other places on the Internet. The ePA process involves digitizing questions and answers in the way any other online survey is done. This would replace the previously hard copy surveys that were mailed out, and reduce the completion time alone to a minute or two.

Yakimischak adds, “One of the big differences with ePA is that some of the answers to the questions can come automatically from the EHR system. The EHR system knows my date of birth. A provider doesn’t have to type that in each time. We can prepopulate that data into the form. Every time someone doesn’t have to retype something, you can reduce the possibilities for errors and you can speed up efficiency. So there’s a big interest in the healthcare community for automating this prior authorization, and we think that over the next couple of years it’s really going to take off and become the predominate method. Three to five years from now, we think paper will be in the minority.”