Rapid patient testing accelerated via automated insurance approvals by Independence Blue Cross and Penn Medicine.
In a bid to improve healthcare efficiency and reduce unnecessary delays, Independence Blue Cross (IBX) and Penn Medicine have joined forces to simplify the prior authorization process locally. The goal is to make the medical management process easier for everyone, as stated by Dr. Rodrigo Cerdá, IBX's chief medical officer.
The joint program grants automatic prior authorization to physicians who meet certain criteria. To be eligible, physicians must have a 12-month history of ordering tests with a denial rate of 2% or lower with Independence Blue Cross. This includes outpatient tests like CT, PET, MRI scans, and echocardiograms.
This automatic approval system brings several advantages. For instance, about 83% of outpatient radiology requests from eligible physicians are approved in one-tenth of the time it typically takes through the standard prior authorization process. This speedy approval process reduces administrative burden, saves time and resources for both providers and the insurer, and eases administrative workloads.
Moreover, the program has contributed to a 9% reduction in “low value” or unnecessary tests, which are unlikely to provide useful diagnostic or treatment information. This reduction promotes more cost-effective care and ensures that healthcare dollars are not wasted on administrative processes.
Dr. Mitchell Schnall, a radiologist, emphasized that many healthcare dollars are spent on the administrative process of prior authorization. By streamlining this process, the joint program allows providers to focus more on patient care, and less on paperwork.
The program has also helped Penn Medicine use its time and resources more efficiently, according to Dr. Schnall. Before, last-minute openings in the radiology department couldn't be utilized due to the need for prior authorization, but this is no longer the case.
Over 1,300 Penn physicians participate in the joint program, and IBX recently expanded the same program to Temple Health. The program is also open to other local health systems and provider groups who are interested in adopting the new reforms.
In the broader context, the process called prior authorization is at the center of reform talks in recent years. Delays in care due to the prior authorization process can lead to cancellations of tests, which can negatively impact patient care and raise costs. By simplifying this process, IBX and Penn Medicine are leading the way in promoting efficient, cost-effective healthcare.
[1] https://www.ibx.com/news/ibx-and-penn-medicine-simplify-prior-authorization-process-for-common-tests-and-imaging [2] https://www.pennmedicine.org/updates/news/features/2021/july/ibx-penn-medicine-partnership-aims-to-improve-patient-care-by-streamlining-prior-authorization-process [4] https://www.healthaffairs.org/do/10.1377/hlthaff.2020.00795
Science plays a significant role in the streamlining of medical management processes, as evidenced by the joint program between Independence Blue Cross (IBX) and Penn Medicine. This program, focusing on health-and-wellness, automatically approves prior authorizations for certain physicians who meet specific criteria, thereby reducing unnecessary delays and medical-conditions related to low-value tests.
