On November 8, the Bree Collaborative convened a special meeting of interested providers and health systems, health plans and others to discuss ways to improve proper authorizations. While WSHA was hopeful that the meeting would lead to a pathway to work with payers on a standardized approach across payers, it is unclear if there is traction for that concept. In addition, it appears that the Office of the Insurance Commissioner may be taking steps to make “gold-carding” type solutions more difficult for providers, due to the agencies concerns about discrimination among enrollees.
WSHA and WSMA had requested the Bree adopt prior authorizations as an area of focus, as the volume and inconsistency of prior authorization requirements places burden on patients, can promote variation in care delivery, and results in inefficient use of health care resources. Dr. Hugh Straley, Chair of the Collaborative, agreed to convene a meeting of stakeholders to have discussions on how to help improve the process. At the meeting, Dr. Bob Mecklenburg of Virginia Mason Medical Center and Dr. Shawn West, Medical Director for Premera Blue Cross shared their efforts to agree on common clinical decision pathways and incorporate them into service delivery.
Jim Freeburg of the Office of the Insurance Commissioner provided an update concerning the OIC’s view of alternative authorization arrangements. The OIC is concerned that there be transparency and consistency of benefits for enrollees that are contracted with the same plan. The OIC is concerned that an approach that provides easier prior authorization at some facilities may create differential benefits. The OIC plans to issue draft rules in spring 2017.
A goal of the meeting was to determine if there was a group of plans and providers willing to work together to identify and build consensus for standard clinical decision criteria for specific sets of services. Dr. Straley indicated Bree members are willing to participate but additional work would need to be driven by plan and provider participants. WSHA and WSMA are looking forward to working collectively on this issue and are interested in hearing from interested potential participants. (Andrew Busz, firstname.lastname@example.org).