The Personal Touch: Provider Outreach Facilitates Better Outcomes for Prior Authorizations
Picture a typical day in a busy medical practice in which a provider encounters many different patients for many indications, each with different treatment strategies and insurance requirements. Now picture a health plan, aiming to control costs and endorse medically necessary practices by managing services requested by thousands of providers for millions of members.
One can imagine that there is not an obvious, natural place for the busy providers and large health plans to have a real, impactful conversation about the care of a particular patient. Health plans may be concerned that increased management efforts could cause unintended provider abrasion.
InformedDNA has been assisting health plans in the management of genetic testing for more than 10 years. A vital and unique component of our Genetic Benefits Management™ solution is engaging with providers during a prior authorization* and/or appeals request to best facilitate medically necessary services. Our team of genetics experts contacts providers to engage in a clinical conversation regarding their patient’s unique circumstances, allowing them to provide additional information or to discuss alternate testing options.
These interactions lead to an increase in approval of appropriate, medically necessary services and allow for a request to be impacted at or near the point of service, reducing unnecessary delays. InformedDNA prioritizes provider communication when we embark upon a genetic benefits management solution. The conversations we have with providers on behalf of our health plan clients enhance the providers’ ability to appropriately use genetic testing and result in a more positive relationship between the provider and payer.
- “When InformedDNA genetic analysts collaborate with the ordering provider, about 50% of the time there is consensus that a more clinically appropriate test than the one initially ordered is available.” –Cigna
Many providers appreciate having access to genetics experts. Our genetic analysts, who work with providers on behalf of health plans, are board-certified genetic counselors with the power of the largest database of genetic knowledge at their disposal. This means that when they reach out to a provider, they know exactly how to facilitate the conversation in the most efficient way. This is valued by the providers and always has the aim of providing the best healthcare for the patient:
- “It was helpful to speak with someone who seemed to have more than just a basic understanding of genetics.” –Provider feedback, April 2018
- “…very thankful to have a genetic counselor reviewing genetic testing requests!” –Provider feedback, September 2018
- “It’s good to be able to speak with a genetic counselor on this topic.” –Provider feedback, September 2018
Because of our genetic analysts’ training, they are expert communicators. Conversations with providers are approached with understanding, empathy, and an eagerness to help. Providers are our partners in ensuring that patients receive the most appropriate and informative genetic testing. Healthcare is a vast labyrinth and our genetic analysts strive to be the navigators, supporting healthcare providers’ needs in the complex process of ordering genetic testing.
- “Approachable and easy to contact” –Provider feedback, May 2018
- “I felt the person actually listened rather than read back their policy. Thanks.” –Provider feedback, June 2018
- “VERY helpful and pleasant” –Provider feedback, August 2018
The outreach performed by our genetic analysts is well received by providers and reflects positively on the prior authorization process of our health plan partners:
- “Most positive experience I have had with insurance company in a long time! Thanks!” –Provider feedback, April 2018
- “Best experience I’ve had with insurance.” –Provider feedback, June 2018
*Our preauthorization solution is provided in concert with our partner, AIM Specialty Health®.
To learn more about our Genetic Benefits Management services for health plans, please give us a call at 800-975-4819; send an email to firstname.lastname@example.org; or, just fill out the form below and we’ll get in touch shortly.