BCBS of Michigan embraces electronic prior authorization

A project at Blue Cross Blue Shield of Michigan offers valuable lessons for the healthcare industry's transition to electronic prior authorization (ePA), according to a Managed Healthcare Executive article.

The current prior authorization process includes paper, phones and faxes, which is a highly inefficient way for physicians to give patients authorization for selected prescription drugs and medical procedures, write James R. Lang, BCBSM's vice president of pharmacy, and Anthony J. Schueth, CEO of consulting firm Point-of-Care Partners. Moving from this antiquated process to an electronic one is easier said than done, but despite the challenges, ePA is gaining momentum, they say.

Recognizing its own need to move from a manual PA system to an ePA, BCBSM created a pilot program to leverage available technology for its medical specialty drug management program.

The program involved a five-part process: Analyze the current system; develop program requirements, fold ePA into BCBSM's newly created strategy to manage drug distribution channels; request proposals and vendor selection; and finally, implement the project and conduct oversight. Even though the process has been costly, the savings have already exceeded initial investments, according to Lang and Schueth.

The insurer has learned that the adoption of ePA may be slower than originally anticipated, and the authors note that internal resources must be aligned to make sure all aspects of medical claims systems are working in alignment. In addition, provider access issues remain, as many are reluctant to add another tool to their workflow.

To learn more:
- read the article

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