hitconsultant.net Open in urlscan Pro
162.159.135.42  Public Scan

Form analysis
4 forms found in the DOM

Name: mc-embedded-subscribe-form-single — POST http://hitconsultant.us2.list-manage.com/subscribe/post?u=d40f6c822eae485b6e25d89dd&id=37fb10719e

<form action="http://hitconsultant.us2.list-manage.com/subscribe/post?u=d40f6c822eae485b6e25d89dd&amp;id=37fb10719e" method="post" id="mc-embedded-subscribe-form-single" name="mc-embedded-subscribe-form-single" class="validate" target="_blank"
  novalidate="">
  <div style="position: absolute; left: -5000px;"><input type="text" name="b_d40f6c822eae485b6e25d89dd_37fb10719e" value=""></div> <input type="email" placeholder="Enter Email Address" value="" name="EMAIL" class="required email" id="mce-EMAIL"
    style="width:100%;float:none;clear:none;"> <input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="button" style="float:none;clear:none;display:block;margin:15px auto 0 auto;">
  <div id="mce-responses" class="clear">
    <div class="response" id="mce-error-response" style="display:none"></div>
    <div class="response" id="mce-success-response" style="display:none"></div>
  </div>
</form>

GET https://hitconsultant.net/

<form class="search-form" method="get" action="https://hitconsultant.net/" role="search"><label class="search-form-label screen-reader-text" for="searchform-1">Search the site ...</label><input class="search-form-input" type="search" name="s"
    id="searchform-1" placeholder="Search the site ..."><input class="search-form-submit" type="submit" value="Search">
  <meta content="https://hitconsultant.net/?s={s}">
</form>

Name: mc-embedded-subscribe-form-sidebar — POST https://hitconsultant.us2.list-manage.com/subscribe/post?u=d40f6c822eae485b6e25d89dd&id=37fb10719e

<form action="https://hitconsultant.us2.list-manage.com/subscribe/post?u=d40f6c822eae485b6e25d89dd&amp;id=37fb10719e" method="post" id="mc-embedded-subscribe-form-sidebar" name="mc-embedded-subscribe-form-sidebar" class="validate" target="_blank"
  novalidate="">
  <p>Latest insightful articles delivered straight to your inbox weekly.</p>
  <div style="position: absolute; left: -5000px;"><input type="text" name="b_d40f6c822eae485b6e25d89dd_37fb10719e" value=""></div>
  <div id="mce-responses" class="clear">
    <div class="response" id="mce-error-response" style="display:none"></div>
    <div class="response" id="mce-success-response" style="display:none"></div>
  </div> <input type="email" placeholder="Enter Email Address" value="" name="EMAIL" class="required email" id="mce-EMAIL"> <input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="button">
</form>

Name: mc-embedded-subscribe-form-footer — POST https://hitconsultant.us2.list-manage.com/subscribe/post?u=d40f6c822eae485b6e25d89dd&id=37fb10719e

<form action="https://hitconsultant.us2.list-manage.com/subscribe/post?u=d40f6c822eae485b6e25d89dd&amp;id=37fb10719e" method="post" id="mc-embedded-subscribe-form-footer" name="mc-embedded-subscribe-form-footer" class="validate" target="_blank"
  novalidate="">
  <p>Latest insightful articles delivered straight to your inbox weekly</p>
  <div style="position: absolute; left: -5000px;"><input type="text" name="b_d40f6c822eae485b6e25d89dd_37fb10719e" value=""></div>
  <div id="mce-responses" class="clear">
    <div class="response" id="mce-error-response" style="display:none"></div>
    <div class="response" id="mce-success-response" style="display:none"></div>
  </div> <input type="email" placeholder="Enter Email Address" value="" name="EMAIL" class="required email" id="mce-EMAIL"> <input type="submit" value="Subscribe" name="subscribe" id="mc-embedded-subscribe" class="button">
</form>

Text Content

 * Skip to main content
 * Skip to secondary menu
 * Skip to primary sidebar
 * Skip to secondary sidebar
 * Skip to footer

 * 
 * 
 * 
 * 
 * 
 * 









Menu
 * COVID-19
 * Opinion
 * Health IT Submenu
   * Behavioral Health
   * Care Coordination
   * EMR/EHR
   * Interoperability
   * Patient Engagement
   * Population Health Management
   * Revenue Cycle Management
   * Social Determinants of Health
 * Digital Health Submenu
   * Artificial Intelligence
   * Blockchain
   * Mobile Health
   * Precision Medicine
   * Telehealth
   * Wearables
 * Startups
 * M&A
 * Value-based Care Submenu
   * Accountable Care (ACOs)
   * Medicare Advantage
 * Life Sciences
 * Research


WHY IT’S TIME FOR INTELLIGENT PRIOR AUTHORIZATION

by Alina M. Czekai, MPH, VP of Strategic Partnerships at Cohere Health
02/09/2023 Leave a Comment

 * LinkedIn
 * Twitter
 * Facebook
 * Email
 * Print

Alina M. Czekai, MPH, VP of Strategic Partnerships at Cohere Health

The Centers for Medicare & Medicaid Services (CMS) recently proposed a new rule
to advance interoperability and improve the prior authorization (PA) process for
Medicare and Medicaid patients. Specifically, the rule stipulates that health
plans adopt electronic prior authorization processes, adhere to shorter
turnaround times, clearly communicate denial reasons, publish key metrics
annually, and implement the Fast Healthcare Interoperability Resources (FHIR)
Application Programming Interface (API). The intent of CMS’s rule is to improve
transparency, reduce physician burden, and accelerate patient access to care. 



This follows closely on the heels of last year’s legislation, the Improving
Seniors’ Timely Access to Care Act, which unanimously passed the House in
September, but did not make it to the Senate floor before this year’s Congress
convened. The new rule from CMS represents additional progress and includes
public feedback from a former iteration of the rule that was proposed in
December 2020. Generally viewed as a highly burdensome process, PA is considered
necessary by health plans to help ensure their members receive safe, quality,
high-value care; however, the process consistently leads to friction with
physicians and delays in care for patients.

Historically, efforts to remedy the PA process have focused on automating health
plans’ existing processes – as if efficiency was the only missing ingredient in
an otherwise sound process. The rule, while designed to help drive greater PA
efficiency and transparency, sets a foundation for payers to do much more –
including reducing unwarranted care variations and better aligning with
value-based care models to more holistic, longitudinal care and driving
evidence-based care paths – all of which can lead to better, faster care. 

It’s true that PA is time-consuming and fraught with administrative burdens for
physicians and staff – typically requiring faxing and even the mailing of
clinical notes. On the health plan side, some employ large call centers to
reduce the administrative burden on their staff. A recent AMA survey revealed
that physicians and their staff spend an average of 13 hours each
week completing PA requests. The survey also found that 93% of physicians say
that PA delays patients’ access to necessary medical care, and 82% of physicians
report that PA processes can sometimes lead to treatment abandonment. 

Indeed, digitizing PA processes, for example by employing the FHIR API, does
accelerate the submission of requests and the ensuing clinical review process.
It does not, however, on its own, transform PA into a more valuable tool for
care management or for reducing unnecessary variations in care. So, a valuable
opportunity for health plans to further improve either quality of care is
overlooked. 

While the provisions for the CMS rule would not go into effect until 2026,
health plans using manual or partially automated PA processes will need to
invest in infrastructure and technology to support this transition well before
then. This pivotal moment provides an opportunity for health plans to adopt
advanced technologies that not only ensure regulatory compliance but enable more
strategic care management. It is time for intelligent utilization management,
beginning with prior authorization.

Using artificial intelligence and machine learning, an intelligent prior
authorization platform can extract patient-specific data from several sources,
including the electronic health record. Armed with the patient’s care history
and evidence-based criteria, an intelligent platform can guide physicians toward
care choices that are likely to improve patient outcomes. And rather than
submitting several disconnected PA requests for one patient, clinicians can get
multiple services approved simultaneously – spanning an entire episode and
effectively speeding patient access to the most appropriate care.

An intelligent prior authorization platform can easily meet the rule’s
requirements for greater automation, more transparency, clearer guidance, and
accelerated approvals by utilizing evidence-based clinical criteria that
are clearly defined and referenceable for physicians. 

The sole focus of prior authorization should be the patient – better outcomes,
better patient experience, and a more clinically appropriate care path.
Electronic PA is surely a good starting point, but it is not enough. To have a
significant impact on the cost and quality of care, healthcare should adopt
intelligent technology that gives providers meaningful support to help achieve
the fastest and best possible outcomes for patients.

--------------------------------------------------------------------------------

About Alina M. Czekai, MPH

Alina M. Czekai, MPH, is the Vice President of Strategic Partnerships at Cohere
Health, a collaborative utilization management technology vendor. Prior to
joining Cohere, she was a senior advisor to Administrator Seema Verma at the
Centers for Medicare & Medicaid Services. LinkedIn –
https://www.linkedin.com/in/alinaczekai/. 

 * LinkedIn
 * Twitter
 * Facebook
 * Email
 * Print

Tagged With: AARP, AMA, American Hospital Association, American Medical
Association, API, Artificial Intelligence, care management, CMS, Electronic
Health Record, FHIR, Healthcare Interoperability, interoperability, Machine
Learning, medicaid, medicare, Medicare Advantage, Notable, Patient Access,
Patient Experience, Payers, physicians, Prior Authorization, Revenue Cycle
Management, Utilization Management, Value-Based Care

Get in-depth healthcare technology analysis and commentary delivered straight to
your email weekly




READER INTERACTIONS


PRIMARY SIDEBAR

Search the site ...


SUBSCRIBE TO HIT CONSULTANT

Latest insightful articles delivered straight to your inbox weekly.




Submit a Tip or Pitch





KNOWLEDGE HUB

How AI Helps Health Systems Improve the Quality of Care for Patients with
Chronic Conditions

10 Critical KPIs Every Successful Healthcare Organization is Implementing


TRENDING

STEVE JOBS’ SON LAUNCHES $200M FUND TO FIGHT AGAINST CANCER

AMAZON CLINIC EXPANDS VIRTUAL HEALTH NATIONWIDE

WHY DIGITAL PATHOLOGY’S ECOSYSTEM WON’T SUPPORT AI STARTUPS

AWS LAUNCHES GENERATIVE AI SOLUTION THAT AUTO GENERATES CLINICAL NOTES

M&A: PRACTICE BETTER ACQUIRES NUTRITION PLANNING PLATFORM THAT CLEAN LIFE

HOW THE VA USES SYNTHETIC DATA TO PREDICT VETERANS’ SUICIDE RISK

M&A: AXXESS ACQUIRES HOME HEALTH EHR COMPLIA HEALTH

AEVICE HEALTH SECURES FDA CLEARANCE FOR SMART STETHOSCOPE WEARABLE FOR
RESPIRATORY MONITORING

ENSURING HEALTHCARE AI/ML MODELS AREN’T “FAILED SCIENCE FAIR PROJECTS”

LIFEBIT PARTNERS WITH LATIN AMERICAN INNOVATORS TO ASSIST GENOMIC DIVERSITY




SECONDARY SIDEBAR




FOOTER


COMPANY

 * About Us
 * Advertise with Us
 * Reprints and Permissions
 * 2023 Editorial Calendar
 * Submit An Op-Ed
 * Contact
 * Subscribe


EDITORIAL COVERAGE

 * Opinion
 * Health IT
   * Care Coordination
   * EMR/EHR
   * Interoperability
   * Population Health Management
   * Revenue Cycle Management
 * Digital Health
   * Artificial Intelligence
   * Blockchain Tech
   * Precision Medicine
   * Telehealth
   * Wearables
 * Startups
 * Value-Based Care
   * Accountable Care
   * Medicare Advantage


CONNECT

 * 
 * 
 * 
 * 


SUBSCRIBE TO HIT CONSULTANT MEDIA

Latest insightful articles delivered straight to your inbox weekly




Copyright © 2023. HIT Consultant Media. All Rights Reserved. Privacy Policy |