Listen Now to Free On Demand Webinar: How Partners HealthCare Eliminates Prior Auth

Amy Krane, Marketing

We were pleased to host Dr. Creagh Milford in a live webinar on Jan 7. Dr. Milford is Associate Medical Director of Population Health Management at Partners HealthCare, a primary care physician, and a former ONC staffer. Dr. Milford shared how Partners HealthCare has implemented a program to achieve 100% appropriate use of the most costly and high volume procedures. Initiated to ensure better outcomes and control costs under their shared risk contracts with payers, the program is now implemented broadly across Massachusetts General Hospital and Brigham & Women’s Hospital.

You can now view it at your convenience here.

In the webinar, Dr. Milford shared how his team has partnered with QPID to implement Q-Guide, which delivers guidelines from the literature and synthesizes them with patient factors automatically gleaned from the medical record. Now, payers such as Blue Cross Blue Shield of Massachusetts are signed on to a pilot project that will allow them to forego the onerous prior authorization process for some procedures where physicians have already attested to appropriate use with Q-Guide. This eliminates a huge administrative burden for providers and relieves patients from waiting for medical necessity reviews to be completed. Most importantly, by using Q-Guide, Partners ensures that healthcare decisions remain in the hands of medical providers and their patients.

Q-Guide covers 15 procedures with more in development. Of these, 7 procedures account for 55% ($56.6 billion) of the 20 most costly surgical procedures in the US. The list is topped by spinal fusion, followed by knee arthroplasty, PCI, partial/total hip replacement, CABG heart valve repair and spine laminectomy.

Partners HealthCare expects to see measurable increases in the rate of appropriate procedures, costs savings from reducing the time spent on prior authorization processes, and a decrease in the number of denials. Clinicians, administrative staff and patients have seen immediate benefits, according to Dr. Milford.

Clinical and frontline staff

  • Improved adherence to best medical practice
  • Enhanced shared decision making with our patients
  • Reduced registry data collection burden
  • New process is easy and reduces administrative burden

Patients

  • Enhanced ability to share in decisions about their care

Administrators

  • Lowering obstacles for prior authorization workflow

You can now view it at your convenience here.