The automation of manual tasks is a trend seen across industries and its promise is particularly meaningful in healthcare, where faster processing of insurance benefits can expedite care. While the biopharma industry has focused on faster turnaround times, that’s just one of the promises of such automation. Josh Marsh, Program Director at Cardinal Health Sonexus™ Access & Patient Support, believes a benefit that’s been overlooked in this transition to eBV/ePA is the improved data quality available once electronic benefits are in place. This deeper understanding of the patient journey yields valuable insights.
“When you call a payer three different times and ask the same three questions, you often get three different answers. The quality of the answer is completely dependent on the caliber of the person who answers the phone at the payer. On the other hand, the robust data we get back in the eBV process opens the door to many possibilities. One area which is not often discussed is how much eBV improves data quality at the hub. This data is ultimately used to create analytics and insights for our clients,” says Marsh. With increased transparency into the details of patient coverage, we can better design tailored patient support programs with curated interventions. What’s more, case managers can anticipate where patients may encounter challenges and proactively guide patients through necessary steps to ensure continuation of therapy. Armed with both comprehensive coverage details from eBV/ePA and an expert understanding of the implications of policy design, hubs can work with HCP offices to inform care plans which suit an individual patient’s coverage.
Taken in aggregate, data from the eBV/ePA process reinforces and informs brand payer strategy. Marsh expands on this topic by reiterating the unique viewpoint hubs have when it comes to payer insights, “Our hub has data visibility and the expertise to discern meaningful patterns for individual patients and for the success of the brand.” Hubs provide data on historical payer trends to determine if projected strategies are working, or if they need to be modified.
Traditionally physicians’ offices and patient support hubs have called payers to query details on individual patient coverage. Today we can automate these tasks by eVerifying benefits and performing electronic prior authorizations. Automation of these tasks is especially timely as they have become the highest volume transactions in today’s medical field according to the CAHQ 2019 Index report. This shift has created an expectation that insurance approvals are now confirmed in a matter of a few minutes, rather than half-an-hour. By reducing the time spent on a manual task, the hub team can focus on labor-intensive tasks like scheduling infusion appointment dates for patients, making adherence calls, and managing affordability programs.
There’s good reason for a focus on expediting insurance approvals and time-to-fill as physician surveys have indicated that delays in care can impact patient well-being. A recent AMA study showed that 91 percent of physicians felt the wait on prior authorization delayed necessary care, and 75 percent of HCPs attribute administrative delays in care to treatment abandonment, 28 percent directly linked adverse events to delays.[i] Healthcare providers working in more stringently managed categories like oncology and rheumatology are adept at navigating insurance approvals; however, they still struggle. Research by Cardinal Health Specialty Solutions confirms the findings of the AMA, with 52% of rheumatology practice administrators citing prior authorizations as a factor in delayed treatments – a critical issue in a category where conditions like rheumatoid arthritis can cause irreversible damage. The benefit of automating the process is clearly beneficial to patient well-being.
In selecting our eBV and ePA methodology, Sonexus™ took a thoughtful approach by piloting the technology to vet its functionality and accuracy. “We appreciate the opportunity to partner with our clients in the evaluation of new technology and solutions. We know they share our interest in exploring new approaches to make the patient journey more streamlined.” Key to the evaluation made by Sonexus™ was ensuring there was no disruption to the HCP and patient experience. We also validated that the information returned during eBV and ePA was accurate on all fronts: patient details, insurance plan specifics and treatment details. It was important to make sure the output was not a conjecture based on historic data, or a calculated projection that might prove wrong. “We’re excited to be building bridges between the data we’re seeing from electronic eligibility and benefits verifications with the other data insights they collect through our ConnectSource platform to tell a 360-degree story about the patient journey.”