There are numerous hurdles in running a profitable oncology practice, but few are as frustrating - or expensive - as the prior authorization process.
Electronic prior authorization and cancer care regimen support tools can help your practice staff streamline the prior authorization process for oral and injectable therapies, reduce staffing support expenses and shorten turnaround times.
Michiana Hematology Oncology, a five site, fifteen physician practice in Northern Indiana, was able to reduce turnaround time for prior authorization to one day.
Michiana has also been able to reduce their first claim submission denials. These results have positively impacted cash flow, staff productivity and staff satisfaction.
Michiana Oncology purchased decision support technology to give physicians access to evidence-based treatment options at the point of care. For the business, it was important to support oncology clinical pathways awareness and compliance for reimbursement. And it gave physicians immediate visibility into available treatments and regimens covered by the patients’ insurance, which resulted in patients receiving treatment sooner.
“The software helps me quickly see what treatments are available, which is particularly useful in third- to fifth-line treatment. It also gives me immediate visibility into regimens covered by the patients’ insurance,” said Dr. Mohamed Farhat, Medical Oncologist.
Treat patients quicker
With visibility into available treatments, patients are given preferred therapies by their insurance to help with the financial impact of their treatment. This has improved patient satisfaction and sped up time-to-treatment.
Improve practice staff productivity
Nursing staff at Michiana can access physician orders, dosing and scheduling easily within the tool to counsel patients on their care plans.
Having an accurate and easily accessible record of regimen and prior authorization details saves nursing staff time by removing the tasks of following up with back office staff and physicians for this information.
There is now lower turnover for the prior authorization team as the software does a lot of the legwork, enabling the team to focus on their primary responsibilities and increasing job satisfaction.
Receive reimbursement sooner
Michiana’s back office staff has measured quicker turnaround for prior authorizations from three or four days on average to one or two days - which means patients can be treated more quickly and reimbursement arrives sooner.
Features of your electronic prior authorization system
When evaluating possible electronic authorization solutions for your practice, here are some features to look for:
- Supports participation in value-based care programs
- Access to NCCN Guidelines at the point of care
- Visibility into treatment cost and coverage for patients
- Access to physician orders, dosing and scheduling
- Information captured as required by payers for prior authorization submissions
- Real-time pathways compliance reporting
- Intuitive and user-friendly interface
- Ease of maintenance and support for IT staff
- Ability to make updates to clinical content centrally
Michiana uses the Clear Value Plus prior authorization solution from McKesson Specialty Health.
"This software helps us manage the intersection of regulatory considerations and patient care. It has helped validate that what we have been doing all along is the right thing and now we know that our physicians will be paid for it,” said Michiana Chief Clinical Officer, Kim Woofter.
Clear Value Plus is a regimen support tool for physicians that highlights evidence-based treatment options and provides financial information at the point of care. The technology helps practices provide high-quality treatment to patients, evaluate cost-effectiveness and efficiently document delivery of evidence-based care.
Learn more about Clear Value Plus
Download the Michiana Hematology case study (PDF, 655, KB)