Transforming Specialty and Oncology Prior Authorizations

October 02, 2023 - In today’s healthcare environment, efficiency and precision are paramount, especially for patients with complex specialty needs. These patients often need specialty treatment regimens delivered quickly, which can be hindered by wait times due to prior authorization.

During an interview with PharmaNewsIntelligence, Lauren Fredin and Brian Arendt, Product Directors at Optum, discussed an innovative solution that is reshaping the healthcare industry, allowing providers to achieve over 60% auto-approval for specialty and oncology prior authorizations within 10 minutes. This revolutionary tool is Specialty Fusion, an advanced prior authorization portal that recommends the optimal treatment for each patient through an intuitive user interface.

"Specialty Fusion significantly expedites the authorization process for both medical and pharmacy benefits, ultimately reducing the time to therapy for patients. Faster approval means quicker access to treatment,” said Fredin. 

A Cross-Benefit PA Solution for Providers 

Fredin emphasizes how Specialty Fusion simplifies the prior authorization process by serving as a one-stop solution for providers. It eliminates the need to navigate different prior authorization processes and portals for different benefits and drug classes, ensuring providers save time checking various platforms. 

Specialty Fusion's intuitive design and user-friendly interface are pivotal in streamlining the PA process. "The tool is highly intuitive, easy to use, and provides a good user experience. It takes 10 minutes or less on average to complete an authorization and get an auto approval at the end — regardless of if the drug is covered under the medical or pharmacy benefit," reassured Fredin. 

Oncology regimens often involve multiple components, including chemotherapy and other drugs like anti-emetics. Specialty Fusion allows providers to get a complete regimen approved, even if a regimen has drugs on both the medical and pharmacy benefit. This approach also eliminates the need to wait for approvals on both benefits.

"Specialty Fusion enables providers to secure approval for complete regimens all at once,” continued Fredin. “This allows patients to get the critical care they need more quickly. 

Personalized, Optimized Care Recommendations

Specialty Fusion's most unique feature is its ability to consider clinical guidelines, care sites, dosage, and more in combination to recommend the most appropriate treatment regimen to the provider during the prior authorization process. This ensures that patients receive personalized and clinically sound treatment options, enhancing care's overall quality and value. 

"Specialty Fusion accounts for clinical guidelines and patient characteristics as well as financial factors like copays and potential drug rebates. By intelligently determining the best combination of treatment, benefit, site of care, and more, Specialty Fusion ensures providers can make the best choice possible for each individual," shared Fredin. 

Providers are guided toward optimal choices through Specialty Fusion's recommendations based on various factors such as clinical guidelines and cost considerations. Providers can see a ranked list of recommendations, explaining why a particular option is preferable, helping them make informed decisions, emphasized Fredin. 

Providers who select a recommended option receive an auto-approval in the tool. For requests that require additional review, Fredin highlights the significance of Specialty Fusion's custom reviews conducted by highly specialized teams, including nurses and medical doctors with experience in complex conditions like oncology. Their expertise ensures that cases are processed quickly, often using a peer-to-peer conversation with the prescribing provider to influence behavior. 

"Optum’s clinical expertise and scale allows our team to handle cases efficiently — these informed conversations with providers in the same discipline drive provider satisfaction and allow us to convert more requests to an appropriate regimen and minimize denials,” said Fredin. 

A Modern User Interface

Arendt emphasized the user-friendly nature of Specialty Fusion's interface. Its design minimizes the administrative burden on medical staff by only requesting essential information and quickly guiding users through the process. 

"There's been a very structured focus on the user experience, striving for minimal clicks in a modern user interface design," mentioned Arendt. 

Arendt explained how Specialty Fusion allows providers to save drafts of prior authorization requests. This feature is invaluable when providers must leave a request and return to it later. The platform also supports cloning requests for ongoing treatments, reducing administrative overhead. 

Specialty Fusion collects data on the efficiency and effectiveness of the platform. This data is used to refine the solution, make policy improvements, and identify bottlenecks, ultimately enhancing the user experience. 

"We're committed to acting on feedback and refining the platform over time to improve the user experience," reassured Arendt. 

Security and Confidentiality 

Protecting patient information is a top priority for Specialty Fusion. According to Arendt, the platform meets all regulatory standards and legal requirements for data security and confidentiality. Patient data is safeguarded within the system and only accessible to authorized individuals. 

“Patient information is treated with the utmost importance — trust hinges on the security and confidentiality of their data,” Arendt stressed. 

Optum's Specialty Fusion is a game-changer in specialty and oncology prior authorizations. It simplifies processes, reduces administrative burden, and partners with providers to make well-informed decisions. The platform's commitment to data-driven improvements, user-friendly design, and security ensures that healthcare providers and their patients receive the best care efficiently and effectively.  

Specialty Fusion heralds a promising future for the seamless management of specialty and oncology prior authorizations, forging a path toward strengthened provider partnerships and improved outcomes for the patients most in need.

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