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  • Clynt Taylor

Could Transparency Replace Prior Authorization for Precision Medicine?

How aligning oncologists, labs, and payers around reimbursement processes can benefit patients and speed cancer care

In a recent Trapelo blogpost Prior Authorization is a Serous Burden to Cancer Care, we discussed many of the reasons that prior authorization fail to support timely, appropriate, and cost-effective care for cancer patients. In short, the current process burdens oncologists and oncology practices with time-consuming paperwork, confusion, and added costs while slowing critical decision-making processes when time matters most for cancer patients.

An AMA survey of 1,000 practicing physicians found that prior-authorization requirements delay treatment, have a negative impact on clinical outcomes, and lead patients to abandon treatment.

92% of the physicians surveyed said that there are sometimes, often or always care delays when patient care requires prior authorization.

It’s time for a new approach to reimbursement for cancer care, and transparency is surfacing as the best, least disruptive solution.

In early 2018, leading payer and provider organizations announced an industry pledge to improve the efficiency of prior authorizations while reducing administrative burden, but they did not address how they will standardize this process. There are many technologies today that assist oncology practices in providing evidence-based care, but few align oncologists, practices, labs, and payers around a transparent model for reimbursement.

Transparency matters, because it allows everyone involved in cancer care to make faster, more appropriate decisions without the burdens and overhead of traditional prior authorization slowing the process down. And when it comes to cancer care, every moment counts.

With today’s focus on the possibilities of precision medicine in cancer care, transparency matters even more. The path from scientific discovery to evidence-based use in practice is fraught with complexity and confusion that can lead to reimbursement uncertainty and unwarranted variability in care. Most companies addressing this market have responded by aligning with a single stakeholder. This exacerbates the problem and limits opportunities for transformative change.

Transparency creates an “all-win” solution for providers, labs, payers and patients, ensuring that appropriate tests are performed for each patient, that the results are clinically supported by evidence, and that reimbursement is considered and assured throughout the practice workflow process.

Trapelo Supports Transparency

Trapelo is the first, evidence-based technology platform that gives oncologists, practices, molecular labs, payers, and pharmacy benefit managers access to real-time, evidence-supported information with unmatched transparency, so they can make the most appropriate decisions for cancer patients while streamlining and optimizing prior authorization and reimbursement arrangements.

Benefits for Oncologists and Practices

Trapelo works with existing prior-authorization solutions and PBM’s to enhance and streamline the reimbursement process. And it features a configurable payor module that facilitates evidence-based support for almost any reimbursement policy.

Benefits for Labs

If the patient’s payer is participating with Trapelo, then the payer’s policy rules may be factored into decision-making processes, assuring the participating lab that the order will be reimbursed, eliminating the need for prior authorization for the order. Orders are pushed electronically to the participating lab along with pre-authorization, reducing administrative effort and ensuring quality.

Benefits for Payers

Trapelo aligns the interests of providers, labs, and payers to deliver better care for patients while managing the costs of precision medicine through transparency and real-time automation. The more these stakeholders align through Trapelo, the more streamlined and cost-effective molecular testing for cancer care will become. Some of the nation’s leading cancer centers and community oncologists along with national and regional molecular testing labs have joined Trapelo.

Contact us to learn more about how Trapelo could work for you. We may already be working in your area.

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