Why BCBS Michigan is cutting 20% of prior authorization requirements

Blue Cross Blue Shield of Michigan intends to cut 20 percent of its prior authorization requirements. James Grant, MD, the payer's senior vice president and chief medical officer, told Becker's the changes are part of an evolving process.  

"We've been continually cutting over the past few years and we're just continuing to take closer looks," Dr. Grant said. "We want to take better care of our people. We've got a problem with clinician burnout, and we want to make it really easy. We want them to be practicing medicine, not spending time on the phone or on a computer. And we really want them to work with us to get our members the care they need when they need it."

Dr. Grant said in deciding what services to cut from prior authorization requirements, the payer looked at the type of procedure and how often it was being approved. 

"So if we're approving something, you know, 99 percent of the time, why are we making [someone] jump through hoops and hurdles to get to that 99 percent?" he said. "There's a lot of things that go into it. Some of the things that we look into is the acuity, like something like breast biopsies. If someone is anxious about whether they have breast cancer or not, we don't want them to sit there and actually wait for us to tell them they can go have a biopsy when the chances are we're going to say yes anyway."

The payer is also in the process of expanding its gold-card program. Helping drive these decisions is improving data.  

"The data we have at our fingertips is so robust and the more we get, the better decisions we can make," Dr. Grant said. "What we want to do is partner with the psychians to make sure that all of our policies and protocols make clinical sense and that they're on board and they're helping to drive that with us." 

He said the goal is to eventually make the process completely automated. 

"Is that going to happen in the next month, six months or even a year? No. It's going to be a slow process," Dr. Grant said. "[…] What we want to do is eventually get people off telephones, for sure get people off fax machines. And if you've got a diagnosis that's in a computer and you've got a procedure that you're asking for, the computer can be able to look it up and say, 'Yes, it's appropriate.' That is where we want to get to one day."

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