How can health systems deliver the right care at the right cost in the right setting, without overwhelming the delivery and reimbursement systems with administrative burden?
Today, prior authorization is a blunt instrument that the industry uses in an attempt to solve the nuanced challenge of how to deliver the right care at the right cost. What’s needed is a contemporary way for payers and providers to connect and communicate about cost and evidence at the point of decision.
Complicating this challenge: Both payers and providers are struggling with the complexity of modernizing legacy systems so they can sustain fee-for-service payment models while embracing coming value-based reimbursement models.
In his latest white paper, , Matthew Zubiller, vice president, strategy and business development at Web2pro, proposes an innovative model that provides a bridge to help achieve value-based decision support.
The paper describes a collaborative, exception-based approach that shifts interactions and decisions from post-care to point-of-care. It also prescribes a shared healthcare cloud that gives payers and providers transparency to evidence, quality and cost, as well as automates authorizations and approvals based on performance and care-event data.
(PDF, 106 KB) to learn how this transformative model for exception-based utilization management and value-based decision making works.