Look at the person next to you. Statistically, one of you likely has some type of cardiovascular disease. How can health plans be more strategic about managing the most expensive chronic condition? (Cardiovascular disease is at the top of that troublesome list.)
Help is coming from an unlikely place. Prior authorization requests provide one of the only data signals of planned medical services before care. Why is “before” the italicized part of that sentence? Well, it’s in the “before” that the impending patient care journey can be optimized.
What does optimizing the care journey mean to you?
Here’s an example: bundled authorizations. A cardiologist requesting a coronary stent might also order blood thinners for postprocedural care. Consolidating multiple authorizations for a single episode of care streamlines cardiovascular care.
I recently penned a white paper about the future of cardiovascular care. Have a look – I hope that you find it useful.
Russell Rotondo, M.D., FACC
Medical Director of Clinical Strategy and Innovation, Cardiology
Featured Content
In this white paper, we explore how health plans can harness intelligent utilization management technology to collaborate with physicians on ensuring a timely diagnosis, the delivery of gold-standard cardiac care, and the best outcomes for each patient.
News You Can Use
📄 House Passes Bill to Install Electronic Prior Authorization in Medicare Advantage Plans (Fierce Healthcare)
Legislative reforms within the “Improving Seniors’ Timely Access to Care Act” will impact the future of prior authorization.
🫀 Why Cardiology is ASCs’ Next Big Thing (Becker’s Healthcare)
Cardiology procedures received the highest estimated Medicare payment increases over the last year, making it the fastest growing ASC specialty.
📈 The Medicare Value-Based Care Strategy: Alignment, Growth, And Equity (Health Affairs)
CMS announced its intention to move all Traditional Medicare plans toward a value-based care approach by 2030.
Cohere Minute
✂️ Improving Utilization Management Can Better Outcomes, Cut Costs in Cardiovascular Care (American Journal of Managed Care)
Positive ways utilization management programs impact patient outcomes in cardiovascular care.
💬 Addressing Health Inequities With Prior Authorization (First Report Managed Care)
The burden of securing prior authorization can act as a barrier to timely care and negatively affect predominantly poor or minority communities.
🔮 The Future of Prior Authorization Under the Improving Seniors’ Timely Access to Care Act (American Journal of Managed Care)
Last month, the U.S. House of Representatives passed legislation that will reform the prior authorization process for Medicare Advantage plans, and now it’s headed to the U.S. Senate.
🤖 How AI and Machine Learning Can Transform Utilization Management (AIThority)
AL and machine learning applications are transforming utilization management programs into a streamlined and collaborative process.
