The Controversial Prior Authorization Process: Care to Care has the Solution
Prior authorizations have been a controversial topic in Health Care for the last decade. However, Care to Care has found a way to minimize misutilization and produce cost savings without being an obstacle to care.
New York, NY (PRWEB) NOVEMBER 20, 2019
Prior authorizations have been a controversial topic in Health Care for the last decade. A recent article by Joanne Finnegan published in fiercehealthcare.com stated that, “In a survey released this week by the Medical Group Management Association (MGMA), 83% of respondents said prior authorizations are ‘very’ or ‘extremely’ burdensome.”
“Having been involved in creating and managing the provision of Prior Authorizations (PA) for medical imaging for over twenty years, I found this statistic to be both predictable and sadly lamentable,” said Michael Komarow, MD, JD, Executive Vice President of Clinical Strategies at Care to Care, a Radiology Benefit Management company.
It is a fact that some systems seem to use delay as part of their Utilization Management (UM) strategy. Whether this is by design or neglect is of no consequence, it is not acceptable. More importantly, it is completely unnecessary. A well-designed PA program is limited to reviewing:
- only procedures with significant misuse potential
- only procedures with significant costs
- using current evidence based criteria
There is nothing esoteric in creating such a program but administering it with patient welfare foremost is critical. At Care to Care, we have endeavored from day one to limit the burden we put on referring and rendering practices by asking as little of them as necessary to perform our UM tasks.
We are proud to have been able to meet or exceed industry UM goals for all our clients; and have fostered a cooperative relation with all of the physician communities with which we work.” said Michael Komarow, MD, JD, EVP of Clinical Strategies at Care to Care.
About Care to Care, LLC
Care to Care is a URAC- Accredited Specialty Benefit Utilization Management company that delivers evidence-based, physician-friendly solutions to ensure payers and their beneficiaries receive cost-effective care by reducing redundant or unnecessary imaging studies. Care to Care, LLC provides Utilization and Network management to government, commercial, and self-funded programs. For more information, visit http://www.caretocare.com.