Providers

Practice Perspectives on Increasing Administrative Burdens: What We’ve Learned

The SamaCare Team

The SamaCare Team

Over the past two years helping hundreds of physicians navigate the burden of prior authorizations for physician administered medications, we’ve learned a lot from our practice partners. These learnings continue to reinforce SamaCare’s mission: to provide practices with the tools they need to streamline the prior authorization process and improve patient care. 

The last 10 years have brought explosive growth in provider administered drugs. Paul Lucas, the CFO and Administrator at Georgia Retina and a SamaCare user, noted that as new drugs have come out in the last 10 years, he’s seen a 30X increase in the number of injections the practice does. As a result, he says they’ve had to adopt a mindset change.

““I don’t like thinking about patient care this way, but in many ways we’ve had to adopt a ‘manufacturer’s mindset’ — focusing on streamlining our process and using automation as much as possible to make sure that we can serve the huge number of patients that we see,” says Lucas. 

The growth in injection volume has come with a corresponding growth in administrative overhead related to getting insurance approval and reimbursement, epitomized by prior authorizations. As Kris Del Monte, Revenue Cycle Manager from Bay Area Retina Associates points out:

““Prior Authorizations are the number one issue for revenue cycle for retina practices. One denied claim for No Authorization can create a financial hardship for any practice. We struggle with this on a daily basis.”

Practices struggle to keep up with this growing burden. Manufacturers have attempted to help with co-pay assistance programs and benefits investigations, but the prior authorization burden continues unabated. In fact, a recent SamaCare-commissioned survey of practices that frequently use physician administered drugs suggests many practices do not engage with / receive support from pharmaceutical market access teams. 

While the majority of practices (78%) indicated they are aware of market access and reimbursement services, the majority (58%) also only occasionally, rarely, or never engage the assistance of pharmaceutical market access teams. 

As we’ve covered in a previous blog post, a data and communications gap prevents manufacturers from being as helpful to practices as they would like to be. This gap is what we built SamaCare to fill — streamlining prior authorizations for physician administered medications across all payers, while providing pharmaceutical manufacturers with the aggregate insight and platform they need to successfully help providers navigate authorization for their medications. 

It has been an insightful two years, and we look forward to continuing to learn from and adapt SamaCare to meet the needs of providers in 2021.


Providers

Practice Perspectives on Increasing Administrative Burdens: What We’ve Learned

The SamaCare Team

The SamaCare Team

Over the past two years helping hundreds of physicians navigate the burden of prior authorizations for physician administered medications, we’ve learned a lot from our practice partners. These learnings continue to reinforce SamaCare’s mission: to provide practices with the tools they need to streamline the prior authorization process and improve patient care. 

The last 10 years have brought explosive growth in provider administered drugs. Paul Lucas, the CFO and Administrator at Georgia Retina and a SamaCare user, noted that as new drugs have come out in the last 10 years, he’s seen a 30X increase in the number of injections the practice does. As a result, he says they’ve had to adopt a mindset change.

““I don’t like thinking about patient care this way, but in many ways we’ve had to adopt a ‘manufacturer’s mindset’ — focusing on streamlining our process and using automation as much as possible to make sure that we can serve the huge number of patients that we see,” says Lucas. 

The growth in injection volume has come with a corresponding growth in administrative overhead related to getting insurance approval and reimbursement, epitomized by prior authorizations. As Kris Del Monte, Revenue Cycle Manager from Bay Area Retina Associates points out:

““Prior Authorizations are the number one issue for revenue cycle for retina practices. One denied claim for No Authorization can create a financial hardship for any practice. We struggle with this on a daily basis.”

Practices struggle to keep up with this growing burden. Manufacturers have attempted to help with co-pay assistance programs and benefits investigations, but the prior authorization burden continues unabated. In fact, a recent SamaCare-commissioned survey of practices that frequently use physician administered drugs suggests many practices do not engage with / receive support from pharmaceutical market access teams. 

While the majority of practices (78%) indicated they are aware of market access and reimbursement services, the majority (58%) also only occasionally, rarely, or never engage the assistance of pharmaceutical market access teams. 

As we’ve covered in a previous blog post, a data and communications gap prevents manufacturers from being as helpful to practices as they would like to be. This gap is what we built SamaCare to fill — streamlining prior authorizations for physician administered medications across all payers, while providing pharmaceutical manufacturers with the aggregate insight and platform they need to successfully help providers navigate authorization for their medications. 

It has been an insightful two years, and we look forward to continuing to learn from and adapt SamaCare to meet the needs of providers in 2021.