Automating prior authorization processes to encourage providers to follow the latest clinical guidance can reduce costs and make care more efficient, according to a recent study conducted by CVS Health.
CVS developed Novologix, a digital clinical decision support prior authorization tool, to streamline the care management process for cancer treatment. The study found that from April to December 2020, 279 prior authorization requests were submitted by an unnamed large health system through the Novologix platform.
Eighty-three percent of those submissions were approved in real time. Ultimately, none of the submissions were denied, as researchers said the remaining 17 percent were reviewed through a partnership with the National Comprehensive Cancer Network.
The study found Medicare Advantage patients with non-small cell lung cancer whose care regimens adhered to the National Comprehensive Cancer Network's guidelines experienced significant cost savings. For patients meeting those guidelines, the average cost of care was $19,321, compared to $26,405 for patients who did not.
"Financial savings by encouraging providers to follow NCCN guidelines may lead to a 27 percent reduction in total cost of care with further proper adjustment on population bias; this may lead to similar findings in other cancer types," the study said.