Commercial health plan policies delay patient care, increase burnout: AHA

A new report from the American Hospital Association suggests that private commercial health plans delay patient care and contribute to physician burnout. The paper, which pulls data from a variety of sources, found that commercial insurance policies, like utilization management tools and prior authorization requirements, create significant barriers to patient care and unnecessarily spike administrative costs – while at the same time commercial insurance premiums have been steadily growing above the rate of inflation. Prices are up some 47% in the last 11 years.

Prior authorization requires physicians to submit their anticipated treatment plan to insurers and receive approval before they can move forward. Notably, not all treatments which have received prior authorizations will be covered by insurance. According to a previous study noted in the AHA report, physicians and staff spend as much as two days a week doing prior authorizations, a resource-intensive process, which contributes to physician burnout.

At the same time, prior authorizations can delay patient care, or even lead patients to switch treatment plans entirely. Around 82% of doctors say that the prior authorization process has motivated their patients to drop anticipated treatment plans.

The report also calls out step therapy or fail-first policies, which mandate patients try cheaper treatment plans before more expensive options. They can be a significant burden on patients as they delay the delivery of optimal care, the AHA report says.

Other potentially harmful practices that the report notes include:

• White bagging, a policy in which doctors cannot distribute in-house medication directly to patients, delaying patient care and increasing risk of errors.
• Use of electronic payment methods, like virtual credit cards, which add extra fees for health care providers.
• Conflicts of interest between commercial insurers and their subsidiary health care companies, such as pharmacy benefit managers.

Read more: Health insurance price data takes time to process

Moving forward, the American Hospital Association recommends that work be done to identify and eliminate unnecessary costs due to the current administrative structures.

“As the nation works to improve the affordability of the U.S. health care system, holding health plans accountable will help to reduce unnecessary spending on administrative processes and services while simultaneously improving patient access to care and reducing undue burden on our health care workforce,” the report says.