Auto-Selecting Medication Based on the Patient’s Existing Authorization
5 min read
Background
Incisive Consultants started supporting Southeast Health over 3 years ago when their Epic implementation kicked off. One of Southeast Health’s goals was to ensure the daily practice of medicine was more about patient care than clicks in an electronic medical record.
The Incisive team looked for every opportunity to support Southeast Health’s pursuit of that goal.
An Opportunity
During the implementation, Incisive Consultants, working with Southeast Health project stakeholders, identified that many oncology centers have an issue with biosimilar medications workflows and getting the correct medication or treatment plan applied to the patient’s chart. In Epic, it can be complicated and lots of “clicks in an electronic medical record” to swap out an entire treatment plan on a patient. Additionally, when a patient’s insurance or other payor authorizes a different biosimilar medication, it was difficult to discontinue an entire plan and apply a new one.
“88% of physicians describe the burden associated with prior authorization as high or extremely high.”
The Solution
Our team wanted to reduce the administrative burden required to select the correct the biosimilar medication for a patient’s treatment plan. To accomplish this, our team built rule based orderable medications that would automatically select the correct biosimilar based on the patient’s authorization. The rules looked at each encounter to verify which CPT/HCPCs code was attached, along with dates and counts, and then selected the proper biosimilar medication to dispense.
Some Challenges
This was very complex build that requires coordination from many teams to work properly. One of the biggest hurdles was ensuring authorizations were attached to the patient’s chart appropriately in Epic. Schedulers had to link the authorizations to the encounters and the medications had to be released on the proper infusion visits. Our Willow team coordinated with the Patient Access and Training teams to ensure the staff understood the proper workflow and its importance for reducing the overall administrative burden. once the workflows were trained and completed properly the build worked very well.
To ease patient safety concerns following the implementation of a new workflow, our team added an additional safety check. We added a generic default medication that could not be verified or administered if a biosimilar authorization was not found on the patient’s chart. This allowed pharmacy to double check which medication should be provided as well as a queue to nursing to check with the authorization team prior to giving the medication. This helped avoid adverse events and improve reimbursement rates since incorrect biosimilars were given far less often.
The Result
Today, Southeast Health is utilizing this configuration and workflow for all their biosimilar medications. They are exploring whether to expand its use other similar medications that are interchangeable based on authorizations. Overall, this solution enabled providers at Southeast Health to spend more time focused on patient care, and less time tackling administrative burdens.