Posts in “Prior Authorization”
The Future of Electronic PA
Session 2 – Salt River 1
Taking the Next Step: ePrior Auth at the Point of Care
Wayne Armstrong, Senior Vice President, Argus
Marc Nyarko, Director of Operations, Humana
Scot Lovejoy, RPh, Chief Pharmacy Officer, Agadia
ACPE UAN 221-999-12-019-L04-P 1.0 Knowledge-based contact hour
A perspective from the industry on interoperability between a Health Plan, PBM,
Point of Care Vendor and Physicians for ePrior Authorization, including challenges
and barriers to adoption. The presentation includes a success story of working
with vendors and their provider community to roll out the capability of prior
authorization at Point of Care; and an example of collaboration between several
entities towards a common vision.
Agadia to Present at PBMI 2012
Stop by Session #2 on Thursday February 23rd, at 1:15 PM at the PBMI Conference in Phoenix AZ to hear about the latest efforts surrounding ePA. Scot Lovejoy RPh, Agadia’s Chief Pharmacy Officer will speak along with representatives of a major Health Plan and TPA to discuss current activities and future trends in electronic Prior Authorization.
See you in Phoenix! 
California Bill Passes Senate
The California Senate has passed SB866 which calls for standardization of Health Plan prior Auth forms in the state. The bill was sent to the Assembly and referred to committee.
California Physicians Pursue the Easy Path
California SB866 is a bill to adopt a standard Prior Authorization form and process for all drugs. Supported by AMS (America’s Medical Society), it is a reaction from physicians to the expense and time required to handle prior auths in their daily practices.
Now, no one doubts the impact that dealing with Plan Sponsors has on the Physician’s office staff time, but on the other hand, Prior Auth has ensured appropriate therepy and provided cost savings as well over the years.
And I believe this is just the beginning. There are discussions and other efforts to standardize not just the forms, but the criteria as well.
Plan sponsors will never agree to this for two reasons I believe;
1. Each plan has their own idea about what criteria are relevant and how detailed they need to be. A “one size fits all” approach will never be acceptable, and
2. Standardized criteria would soon render the whole process worthless. The comoditization of clinical criteria would not only provide little value, but would only serve to increase beuracracy and impede the flow of new evidence based recommendations.
By the time some “agency” incorporates the latest clinical knowledge into the criteria, it could be too little too late.
Prior auth does serve as a tool to disseminate the latest clinical experience and therapuetic thinking across the medical landscape. And that is a process that is already too slow in medicine today.
This effort by physicians in California although understandable, is misguided. There already exist other solutions to reduce the time and hassle of dealing with the Prior Auth process (online portals for example). As they are adopted and become more available to a larger physician population, the administrative burden will be reduced.
What do you think? Other ideas to alleviate the burden for Physicians?
Press Release
Agadia to Promote PAHubTM at 2011 AHIP Conference
Pre-certification solution reduces costs
Parsippany, N.J. – June 6th, 2011 – Agadia Systems, Inc. today announced;
They will be a sponsor of the AHIP Institute 2011 in San Francisco, CA.
“We will be highlighting our pre-certification automation solution PAHubTM, and demonstrating the ability to reduce administrative costs associated with these processes” said Scot Lovejoy RPh, Chief Pharmacy Officer for Agadia.
PAHub, the industry leading Prior Auth/Pre-certification automation solution handles not only prescription drugs under a variety of benefits, but also handles Radiology, other medical procedures, Durable Medical Equipment, Admissions, and just about any other service that can involve criteria that must be met for approval.
“Agadia has consistently lead product development with out-of-the-box thinking focusing on replicable feature-sets to reduce our overall cost of ownership”. – J.J. VP of IT, Benefit Manager
About Agadia Systems, Inc.
Agadia’s mission is Improve the Quality of Care and expedite the delivery of critical health care services by advancing and automating the Utilization Management process. They have been providing end to end Prior Authorization solutions to Health Plans, PBM’s and TPA’s since 2007, addressing their needs across all pharmacy and medical benefit services.
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All product and company names herein may be trademarks of their respective owners.
Contact information (press members only):
Scott L Furletti
Agadia Systems, Inc.
973-540-8400
Furletti.scott@agadia.com
Physicians are Concerned
The average physician in a solo or two-person practice spent 3.5 hours weekly interacting with health plans (4.3 hours for primary care physicians, data not shown).
Nursing staff spent 13.1 hours per physician per week on authorizations—far more than any other type of staff and far more than nurses spent on any other type of interaction.
Continue reading ‘Physicians are Concerned’
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