Pharma must address the mounting administrative burden facing providers or face the certain consequences.
Providers are faced with a crushing amount of administrative activities. It’s not a new problem. It’s a mounting one. Healthcare providers spend notably more time completing administrative work today because of the current value-based healthcare model with its focus on controlling costs through limiting reimbursements and adding approval-type requirements.
Why the Burden?
The additional gates put in place by PBMs and payers to confirm correct therapy path and/or clinical requirements before paying up are far too time consuming and complicated. Processes and documentation are redundant and often require rework primarily as a result of submitting incomplete forms.
Why Should Pharma Act?
If a brand or portfolio of products is more difficult to complete prior authorization for reimbursement or step therapy documentation then the products will never garner the proper usage deserving or not. Ultimately, this means pharma companies that successfully and cost-effectively assist providers in coordinating better care across the care continuum will be those that survive. Having the important information necessary regarding reimbursement or step therapy processes and lessening the administration burden will prove invaluable.
1. Standardize forms. Integrate with EHR. Provide Supplemental Education.
There must be a digitalizing and standardization of documentation in format and layout across all brands at least within the organization to mitigate confusion, frustration and redundancies. In digitizing forms, there must be a focus on user experience. Documents and forms must be simplified; clearly outline requirements and expectations while also being consistent across related documentation and brands.
Integration with EHR is essential. Information already gathered and documented within EHR systems should be automatically imported into required documentation and forms. Digital forms should alert users of missing information and include reminder prompts and progress status for easier tracking.
In conjunction to digital, redesigned forms, necessary support—in the form of tools and resources such as succinct training, reference materials or job aids—must be provided. The administrative burden of unclear processes which results in rework must be addressed by getting it right the first time. In other words, enabling providers and patients by removing any confusion.
2. Provide Resources to Lessen Regulatory Oversight Admin Burden.
Pharma must also address the added burden of increased regulatory oversight. Provide relevant, credible, standardized references for case notes and related tools, while also providing consistent patient-centered care coordination and education guides. Content should include population health, key opinion leader views, treatments, as well as the essential education tools specific to optimize outcomes and KPIs. By providing these resources pharma will take the guesswork out of administrative processes and streamline documentation related to added oversight.
3. Focus on Outcomes.
Finally, to lessen the administrative burden pharma must identify KPIs and give outcomes a voice in this value-based day and age and as formulary decisions increasingly pivot on outcomes. First the KPIs most influenced by patient access and support must be identified. Then the focus must be on training as well as support for collection and reporting of appropriate data throughout product messaging.
The companies that act now to remedy the administrative burden in the ways outlined above will be those that have an impact. Those that do not will struggle to stay relevant and impactful in the evolving healthcare landscape.