Page 10 - Delaware Medical Journal - January/February 2019
P. 10
PRESIDENT’S PAGE
was a stop-gap measure and discussions continue. The Primary Care Reform Collaborative and the Delaware Health Care Commission are developing long- term recommendations regarding primary care payment and payment for chronic care management. As investments are made in primary care services, the rate of increase of the total cost of health care in Delaware should decrease.
The third arm in MSD’s strategy to lower Delaware health care spending is to use MSD’s subsidiary, Medical Network Management Services of Delaware,
LLC (MedNet), to improve physician access to better information technology for population health management with the help of MedNet’s minority partner, HealthEC. The majority owners are the doctors of Delaware who are MedNet stockholders. HealthEC is a health information technology company that
can mine data from any source in any content. HealthEC has integrated with more than 60 different electronic medical records (EMRs) and can utilize data
from insurers, the DHIN, pharmacies, and long-term care facilities. By unifying patient data across the health care spectrum in near-real time, the platform will make chronic care management much more effective. This should minimize
duplication of effort and maximize the opportunity to keep chronic care patients out of the emergency room and hospitals. Improved chronic care management will substitute low-cost outpatient treatment for high-priced in-patient treatment, and the rate of increase of the total cost of health care in Delaware should slow.
The fourth arm in MSD’s strategy to lower Delaware health care spending
is to use blockchain technology to streamline the prior authorization process. The concept, for example,
is for a physician to upload the last clinical note justifying the need for a radiology study onto the DHIN and
to expect an answer from the insurer
in minutes, not days. Presently, every hospital and independent physician spends a large amount of resources on
a futile preauthorization process that increases the cost of care, increases the therapy. Billions of dollars are wasted nationwide. When a PCP is denied, they have two choices. One is to call the insurer and argue. This wastes hours
on the phone. The second option is to order a consult and have the specialist order the study. Then the insurer pays for the consult and the study. While the patient is waiting for the consult, they
frequently become anxious. Rather than wait for the consult, they go to the ER and get the study right away.
Prior authorization denials do not keep
a lid on health care spending. Prior authorization denials greatly increase the cost of Delaware health care spending due to the reasons mentioned above.
To make matters worse, the money that managed care organizations (insurers) spend internally on the preauthorization process is accounted for as money
spent on patient care (not as overhead and administration cost). This money could be spent on true patient care or be refunded to the patient. By streamlining or eliminating the prior authorization process, we can save billions of dollars of wasteful health care spending and the rate of increase of total cost of health care in Delaware should slow.
If you have other ideas for lowering the rate of growth in health care spending in Delaware, please contact me and share your thoughts.
Thank you,
Andrew W. Dahlke, MD
President, Medical Society of Delaware
REFERENCES
1. Bazemore A, Petterson S, Peterson LE, Phillips RLJ. More Comprehensive Care Among Family Physicians Is Associated with Lower Costs and Fewer
Hospitalizations. Ann Fam Med. 2015;13(3):206-13.
10 Del Med J | January/February 2019 | Vol. 91 | No. 1
