There is a crescendo of policies and programs for healthcare interoperability and electronic prior authorization, but it is a complicated proposition, says Kim Boyd at AMCP Nexus 2022.
No one seems to disagree that data ought to flow more freely through the U.S. healthcare system and that processes like prior authorization should happen faster and be more automated
But in a session today at the AMCP Nexus 2022 meeting, Kim Boyd sketched a complex picture development of technology standards and statutory and regulatory history.
“The path to interoperability and specifically to PA (prior authorization) improvement and automation, data and cost transparency is one that has lots of curves, speedbumps— and a lot of roadblocks,” said Boyd, who is senior consultant, regulatory resource center lead for Point-of-Care Partners, a healthcare IT management consulting company in Hollywood, Florida.
But Boyd also spoke about a “crescendo of polices and standards” to improve interoperability — the ability of different healthcare IT systems and devices to communicate with each other — and patient empowerment.
Boyd traced the legislative and regulatory history of interoperability and electronic prior authorization back to the 21st Century Cures Act. Federal action went into something of a lull during the height of the COVID-19 pandemic, Boyd said, so many states have stepped in with laws or rules concerning data-sharing.
Boyd also described the prominent role of the standards development organizations,such Health Level 7, which developed the Fast Healthcare Interoperability Resources (FHIR) standard — referred to almost exclusively by its acronym, FHIR (pronounced fire). She also mentioned the National Council for Prescription Drug Programs and X12.
Boyd noted the growing role of specialty medication in healthcare and the difficulties it poses for streamlining and automation.
“Specialty pharmacy today has no clear or consistent entry point to automation,” Boyd said. “The current state of specialty prescribing drives us to use portals, web searches, cheat sheets and binders.”
How Prime Therapeutics Tugged on the Reins of the Galloping GLP-1 Spend | AMCP Nexus 2023
October 20th 2023The Minnesota-based pharmacy benefit manager says a program that resulted in patients switching from two incretin therapy prescriptions to one yielded $7,500 in savings per patient and a total of $3.5 million.
Read More
Race, Income Impact Specialty Drug Use of Autoimmune Condition Treatments | AMCP Nexus 2023
October 20th 2023In a platinum award winning poster presented at the AMCP Nexus 2023 conference in Orlando, “Specialty drug use varies by race and wage among employees with employer-sponsored health insurance,” authors expressed that spending on specialty medications for autoimmune conditions has increased in recent years, raising affordability concerns for employers.
Read More
The Oncology Pipeline Is Delivering Exciting New Treatments — and Sticker Shock | AMCP Nexus 2023
October 19th 2023Research continues to develop new therapies for rare cancers and to provide options that allow for fewer toxicities. At the same, however, more new drugs are launching with high price tags.
Read More
The Benefits of ML, AI Use in Managed Care Pharmacy | AMCP Nexus 2023
October 19th 2023Adopting evolving computer system tools like artificial intelligence and machine learning in managed care pharmacies have resulted in efficiency when addressing the challenges they are faced with, according to Jessica Hatton, PharmD, BCACP, associate vice president of Pharmacy at CareSource and Nick Trego, PharmD, senior vice president of Clinical Analytics and Client Services at HealthPlan Data Solutions, Inc.
Read More
Outcomes From Horizon BCBS of New Jersey Oncology Home Infusion Program | AMCP Nexus 2023
October 19th 2023The program yielded savings of $25,000 per patient in its pilot phase but is not expected to produce savings as a routine offering because reimbursement for home infusion was matched to reimbursement at a facility. Horizon executive Timothy O’Shea, Pharm.D., M.S., says cost savings were a “secondary outcome” of the program and noted the high patient satisfaction.
Read More
How Prime Therapeutics Tugged on the Reins of the Galloping GLP-1 Spend | AMCP Nexus 2023
October 20th 2023The Minnesota-based pharmacy benefit manager says a program that resulted in patients switching from two incretin therapy prescriptions to one yielded $7,500 in savings per patient and a total of $3.5 million.
Read More
Race, Income Impact Specialty Drug Use of Autoimmune Condition Treatments | AMCP Nexus 2023
October 20th 2023In a platinum award winning poster presented at the AMCP Nexus 2023 conference in Orlando, “Specialty drug use varies by race and wage among employees with employer-sponsored health insurance,” authors expressed that spending on specialty medications for autoimmune conditions has increased in recent years, raising affordability concerns for employers.
Read More
The Oncology Pipeline Is Delivering Exciting New Treatments — and Sticker Shock | AMCP Nexus 2023
October 19th 2023Research continues to develop new therapies for rare cancers and to provide options that allow for fewer toxicities. At the same, however, more new drugs are launching with high price tags.
Read More
The Benefits of ML, AI Use in Managed Care Pharmacy | AMCP Nexus 2023
October 19th 2023Adopting evolving computer system tools like artificial intelligence and machine learning in managed care pharmacies have resulted in efficiency when addressing the challenges they are faced with, according to Jessica Hatton, PharmD, BCACP, associate vice president of Pharmacy at CareSource and Nick Trego, PharmD, senior vice president of Clinical Analytics and Client Services at HealthPlan Data Solutions, Inc.
Read More
Outcomes From Horizon BCBS of New Jersey Oncology Home Infusion Program | AMCP Nexus 2023
October 19th 2023The program yielded savings of $25,000 per patient in its pilot phase but is not expected to produce savings as a routine offering because reimbursement for home infusion was matched to reimbursement at a facility. Horizon executive Timothy O’Shea, Pharm.D., M.S., says cost savings were a “secondary outcome” of the program and noted the high patient satisfaction.
Read More
2 Commerce Drive
Cranbury, NJ 08512