Getting Patients on Appropriate Therapies Faster

Real-Time Prior Authorization in Action

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According to a recent survey from the American Medical Association (AMA), administrative tasks and lack of time are the top two challenges facing physicians today.https://ehrintelligence.com/news/administrative-burden-remains-top-challenge-for-physicians An overwhelming 84 percent of physicians reported that prior authorizations (PAs) take 14.6 hours on average to complete each week — the equivalent of two business days — taking up valuable time physicians could otherwise be spending with patients.https://healthpayerintelligence.com/news/prior-authorization-issues-contribute-to-92-of-care-delay

CVS Health offers several solutions to help physicians provide more coordinated care and ensure their focus stays where it should be — delivering high-quality patient care. Among them, is electronic prescribing (e-prescribing), which is now more widely available than ever before. This digital connection affords more flexibility and greater opportunity to streamline the prescribing process.

Coordinated Care through Better Connectivity, Knowledge Sharing

Plan members with complex chronic conditions rely on multiple health care providers for treatment. If those providers do not communicate with each other, the quality and efficacy of care can be at risk. Lack of care coordination can result in poor clinical outcomes, repeated hospitalizations, excessive utilization of prescription drugs, member dissatisfaction with care, and higher costs for payors and members.

Through our relationships with Surescripts, Epic, and other connectivity platforms, we can connect with providers across the care continuum to share real-time benefits and clinical information, close gaps in care, and help them make more informed treatment decisions. Our connection with electronic health records (EHRs) offers unparalleled depth of data — new prescriptions, hospitalizations, comorbidities, new diagnoses, and more — which provides a more complete clinical picture of each patient and helps ensure higher-quality care. CVS Health clinicians — Accordant and Coram nurses, and MinuteClinic practitioners — can access a member’s EHR to share patient interactions and keep all providers informed on a patient’s progress between office visits.

Payors benefit, too. More coordinated care can help improve health outcomes and lower overall health care costs.

Simplifying the PA Process

While PAs are a critical cost containment tool for payors, the current manual process, which requires multiple phone calls and faxes, can lead to delays in treatment and members dropping off therapy. The AMA’s data support this, revealing that 78 percent of physicians believe PAs can result in patients stopping a recommended course of treatment.http://www.hii.iu.edu/the-prior-authorization-burden-in-healthcare/

The ePA process is up to five times faster than the manual process, with decisions returned to physicians in as little as six seconds

The ePA process is up to five times faster than the manual process, with decisions returned to physicians in as little as six seconds.

CVS Health offers electronic PA (ePA) — a faster, more convenient PA process. While the traditional PA process, using phone calls and faxes, can take anywhere from two to eight days, the ePA process is up to five times faster, with decisions returned to physicians in as little as six seconds. The ePA process follows the same clinical and plan guidelines, we are simply helping make the process more efficient to avoid delays in patients getting started on their appropriate therapy.

Transforming the Specialty Onboarding Experience

Initiation of a specialty therapy can be a key pain point for members and physicians. The traditional process involves completing multiple, complicated forms, as well as time-consuming back and forth with the specialty pharmacy and can often take several weeks for patients to receive their medication.

Specialty Expedite helps get patients on therapy faster by using our integration with EHR systems to streamline the benefits verification and PA process*. Once the provider enters the prescription in the EHR, we seamlessly gather information that is necessary to process a specialty prescription and complete the appropriate PAs, in accordance with payor requirements. Using this information, we can immediately perform safety checks, confirm clinical information, and initiate the PA process and benefits check to help minimize the time between prescribing and the start of therapy. With Specialty Expedite, the onboarding process is dramatically shortened — to as little as three days — while still following the same rigorous clinical standards and plan guidelines.

Visibility to Member Plan Information, Lower-Cost Options

We’re also using EHRs to share member-specific plan and cost information with providers. As out-of-pocket (OOP) costs continue to grow, members may look to their doctor or pharmacist for guidance on making cost-effective choices that align with their plan design. Historically, providers have not had benefit and cost information available at the point of care.

To enable providers to take action to help patients save money right at the point of prescribing, CVS Health launched real-time prescription benefits, which provides visibility to member-specific OOP cost and benefit information. When a physician searches for a drug in their EHR or e-prescribing portal, they will instantly:

	Know if the drug is covered and the member’s OOP cost
	See up to five clinically appropriate lower-cost brand and generic alternatives
	See which options require PA or are subject to other utilization management strategies.

We will continue to look for ways to use EHR connectivity and other digital tools to help streamline the prescribing and onboarding process. A simpler process means patients can begin the appropriate therapy sooner and providers can devote more time to patient care, leading to a better patient experience, improved health outcomes, and lower overall health care costs.