While the federal health care debate rages on, North Carolina lawmakers are pursuing an innovative health care law that both sides of the political aisle can support.
The proposal, currently being studied by the General Assembly, would unleash the power of technology to make Medicaid more efficient and expedite patient care. If passed, the law would require North Carolinas Medicaid program to conduct all prescription approvals, or prior authorizations, electronically.
It may sound like a trivial change. But the current prescription process for Medicaid and for many private insurers is laborious for health care providers, pharmacists and patients.
Whenever a physician prescribes a treatment or medication that is not on Medicaids list of preferred drugs, the treatment requires prior authorization from Medicaid officials before it can be dispensed to the patient. The physician must mail and fax authorization forms to Medicaid in a lengthy approval process that delays treatment for the patient and increases system-wide costs.
With this new electronic system, North Carolina could put an end to this exhaustive paper trail.
Under the proposed system, all 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.
No more forms. No more faxes. And no more waiting.
This little change would have a big impact on both the cost and quality of care for Medicaid patients in North Carolina.
Kansas recently implemented a similar proposal for its Medicaid program, and that state expects to save $1.5 million in the first year. North Carolina legislators should continue to advance this proposal and join other states in finding such savings.
Aside from cost-savings, we know that electronic prior authorization will accelerate the treatment process for Medicaid patients, while relieving the burdens on both physicians and pharmacists.
The current prior authorization process keeps sick patients waiting. Their conditions can worsen while the treatments they need are caught in limbo.
The American Medical Association recently released a membership survey on prior authorization. It found that 69 percent of physicians typically wait several days to receive prior authorization, while one in 10 wait more than a week.
Meanwhile, health care providers waste valuable time on the prior authorization paper trail. Physicians can spend up to 20 hours per week just dealing with prior authorization requests, and studies have shown the costs to physicians nationwide can reach $23.2 billion to $31 billion a year.
A recent survey of pharmacists found that 61 percent were aware of an incident when prior-authorization requirements adversely affected patient care. Pharmacists also find prior authorization time-consuming, with pharmacists spending, on average, nearly five hours a week on requests.
Our state can reduce health care expenditures while improving health care for at-risk North Carolinians and facilitating cooperation among health care professionals just by embracing health information technology.
In a time of fierce health care debates, this is a proposal everyone can stand behind.