By Robert B. Willson, II, MD
North Carolina legislators have the unique opportunity this year to unleash the power of technology and make health care more efficient and cost-effective for physicians, patients and our state’s entire healthcare system.
Across the state, physicians like me are utilizing health information technology, or “health IT.” This cutting-edge technology provides a more complete picture of the patient’s health by allowing doctors to easily access the patient’s full treatment history and inform our treatment decisions. Health IT systems also give us direct access to other caregivers and pharmacies, dramatically increasing cooperation quality of care and overall efficiency.
With health IT systems, physicians also have the ability to electronically prescribe medications – sending them directly to the pharmacist’s inbox. But because of insurance-related roadblocks, I can’t use my health IT system to make sure my patent actually receives the correct prescription.
Health IT truly has the potential to transform health care in North Carolina, but significant barriers must be lifted by our state lawmakers before the promises of technology can be realized.
Like physicians across the state, insurance barriers prevent me from knowing if my patient’s insurance company will cover the treatment I electronically prescribe, or even if my patient will be switched at the pharmacy to an entirely different treatment.
Insurers often demand pre-approval, known as “prior authorization,” before covering a physician’s intended prescription. My health IT system theoretically allows me to obtain a prior authorization electronically, but insurance companies have been reluctant to accept electronic prior authorizations or electronically provide the coverage information I need to request them.
Instead, I must wait until a patient is denied at the pharmacy, and then contact the insurance company the old fashioned way – with time-consuming faxes and phone calls. Meanwhile, the care my patient’s require remains delayed.
The current prior authorization process keeps sick patients waiting. Their conditions can worsen while the treatments they need are determined by the prior authorization process put in place by the insurance company.
The American Medical Association recently released a membership survey which found that 69 percent of physicians typically wait several days to receive prior authorization, while one in ten wait more than a week.
A proposal being considered this year by North Carolina legislators represents the first step in correcting this problem. Under the proposed legislation, prior authorizations and communication between the doctor, Medicaid and the pharmacy would be electronic—seamlessly allowing patients to quickly and efficiently receive the care they need, while saving the state time and money. Fewer forms and faxes, and faster care for patients.
Kansas recently implemented a similar proposal for its Medicaid program, and the state expects to save $1.5 million in the first year.
By mandating that Medicaid accept electronic prior authorizations, North Carolina could start putting an end to this exhaustive paper trail. The next step would be mandating similar cooperation from private insurers so we can modernize health care across the state.
HIT systems have the potential to transform our health care system in North Carolina, but we need the General Assembly to act in order to realize the full potential of this new technology.