Leaders at Geisinger wanted a way to reduce physician burnout. Thanks to a team of pharmacists and pharmacy technicians, they are doing just that by tackling one of the biggest headaches in medical practice today: prior authorization.
Physician burnout has been an ongoing concern for years and was only exacerbated by the COVID-19 public health emergency. After reaching an all-time high of 62.8% in 2021, physician burnout fell below 50% for the first time since 2020, according to exclusive survey data from the AMA.
Still, that means nearly one in two physicians continues to experience at least one symptom of burnout.
To help address that, Geisinger focused on alleviating one of the major catalysts for physician burnout: prior authorization.
Geisinger is a member of the AMA Health System Program, which provides enterprise solutions to equip leadership, physicians and care teams with resources to help drive the future of medicine.
Three leaders from Geisinger talked about addressing prior authorization and how they're helping give time back to physicians in a recent episode of “AMA Update.”
The problem with prior authorization
“Prior authorization is a health plan cost-control process that requires health care professionals to obtain advance approval from the health plan before a prescription medication or medical service qualifies for payment and can be delivered to the patient,” says the 2024 AMA prior authorization physician survey (PDF).
That process often negatively affects patients, physicians and the entire U.S. health system. According to the 2024 AMA prior authorization physician survey:
- 93% of physicians report care delays due to prior authorization.
- 89% of physicians report that prior authorization somewhat or significantly increases physician burnout.
- 88% of physicians report that prior authorization led to higher overall utilization of health care resources.
- 58% of physicians with patients in the workforce report that prior authorization impacted patient job performance.
- 29% of physicians report that prior authorization led to a serious adverse event for a patient in their care.
Leaders at Geisinger noticed similar trends within their health system.
"We were delaying care to patients," said Jerry Greskovic, vice president of ambulatory pharmacy services at Geisinger. That’s "not something we want to do."
Geisinger created a centralized pharmacy Services team made up of pharmacists, pharmacy technicians and pharmacy support associates to support the prior authorization process in a more efficient and effective way. The team manages about 90,000 prior authorizations a year.
“Pharmacy techs or medication-access coordinators will work with a clinic's providers using various EHR tools to streamline and take full ownership of the prior auth process," said Seth Gazes, Geisinger's associate vice president of pharmacy strategy and planning. “They'll communicate actively back to the clinics so that we're able to close the loop, and the patients can go on their way."
The AMA is fighting to fix prior authorization by challenging insurance companies to eliminate care delays, patient harms and practice hassles.
The standard of care in physician well-being recognition
Institutions in this article have been honored by the Joy in Medicine™ Health System Recognition Program.
Giving time back to physicians
Pharmacy technicians play a critical role in removing the burden that prior authorization places on physicians, according to Kristen Kruszewski, Geisinger's director of pharmacy strategy.
“We really try to focus on what we can do to alleviate any of the clinic burden and really push back on what needs to be at a physician level, what needs to be at a nurse level, and really, what can be at an administrative level," Kruszewski said. "Looking at that from a global perspective really let us drive forward with a number of these initiatives."
Pharmacy technicians or medication-access coordinators rely on EHR tools to work with physicians and streamline the prior authorization process. The centralized pharmacy team will submit prior authorization requests and also manages laboratory monitoring, clinical pharmacy services and refill management as needed. And if anything needs to be reworked with the prior authorization request, the team handles that as well.
Preliminary data indicates the health system's prior authorization acceptance rate is more than 30% higher than when clinics oversaw the process. "When you have pharmacists and pharmacy techs up front, they can resolve a lot of issues," Greskovic said. "We're not going back and forth four times with the payer. We know immediately [if] it's either covered [or] not covered. If it's not covered, let's switch to a drug that is."
Initiating the pharmacy team into the Geisinger workflow saved about three to four hours for physicians and other clinic team members every week, according to Greskovic.
The centralized pharmacy services team was initially piloted at a few small clinics, but once other physicians within the health system heard about the initiative, they were eager to have the team's reach expand.
"Once the word got out and we were able to work through some initial issues [with] our workflow, there was really a buzz on the street," Gazes said. "It really just generated a lot of momentum for the program."
Helping physicians and patients
Gazes believes the reason for the team's success starts with how Geisinger approached the problem.
"The first thing we had to do was really understand what the volume of prior authorization work out there was so we knew what size operation we would need to centralize and what that process would look like," he said. "The second thing we really wanted to understand is what that burden was on the staff so we knew what impact it would have."
With that information, Geisinger was able to develop a staffing plan and rollout schedule based on region and specialty.
The development of the pharmacy team was intentionally agile to allow for feedback and adjustments as the rollout began. Now this team’s role is growing to help patients overcome another big obstacle to accessing medications: high prices. "We know that the cost of medications is one of the hardest things for many of our patients," Kruszewski said. "In 2023, we connected over 4,000 patients to our financial assistance program."
The hope is to continue expanding the team's reach. The ultimate goal, Kruszewski said, is to expand the program to cover all points of entry for medication and prior authorization requests so that they can support patients from the moment they reach the hospital all the way through discharge and any necessary follow-up.
In doing so, the team will remove burdens from physicians while working to improve patient outcomes.
"We want to keep them out of the hospital," Kruszewski said. "If we can help in any way, it's a benefit for not just our health system, but also for the patient overall."
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