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Featured topic and speakers
Who is responsible for getting pre-authorization? How can pharmacists help doctors? What can the technician do to help expedite prior authorization?
Our guests from Geisinger Health System are Kristen Kruszewski, director of pharmacy strategy, Seth Gazes, associate vice president of pharmacy strategy and planning, and Jerry Greskovic, vice president of ambulatory pharmacy services. AMA Chief Experience Officer Todd Unger hosts.
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- Reforming Medicare payment
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Speakers
- Kristen Kruszewski, director of pharmacy strategy, Geisinger Health System
- Seth Gazes, associate vice president of pharmacy strategy and planning, Geisinger Health System
- Jerry Greskovic, vice president of ambulatory pharmacy services, Geisinger Health System
Transcript
Greskovic: Today 90,000 authorizations a year go through this team. So you can imagine the workload that that's taken off our clinic staff, our doctors, our nurses.
Unger: Hello and welcome to the AMA Update video and podcast. Today, we're talking about how one health system is reducing physician burnout, thanks to a new program that's focused on centralizing prior authorization through a team of pharmacists and pharmacy technicians.
Joining us today is the Geisinger Health System team that worked to develop this program. Kristen Kruszewski is the director of pharmacy strategy. Seth Gazes is the associate Vice president of pharmacy strategy and planning. And Jerry Greskovic is the vice president of ambulatory pharmacy services. I'm Todd Unger, AMA's chief experience officer in Chicago. Thanks for all joining us today.
Greskovic: Thank you for having us.
Unger: Well, it's interesting—just a little piece of trivia. When we started the AMA Update back in the pandemic, we were using Microsoft Teams, and it allowed us to have three guests. And so we were always having three guests. And then we quickly realized that didn't work very well.
So this is one of the first times we've had three guests, but it's not because of technical needs. It's because of teamwork. And so I'm really excited to have the three of you on board to talk about this program. And Jerry, why don't we start with you and get a little bit more background on the specifics of the program. Why don't you give us a high-level overview of what the program is and what prompted Geisinger to do this in the first place?
Greskovic: Yeah. Great question, Todd. So yeah, what we have done is we created a team we call CCPS—Centralized Clinical Pharmacy Services. It's a group of pharmacists, pharmacy techs and pharmacy support associates who's really main goal is to target high-volume, high-value initiatives that we could support and manage remotely in a more efficient and effective way.
The answer—the reason why we went in that direction is really just physician burnout, admin time with regards to clinic staff. We noticed that we didn't have a ton of people out there that had expertise in this space and how to do it, do it well and do it quickly. And lastly, the important thing with prior authorizations is that we were delaying care to patients, not something we want to do.
Unger: Absolutely. You said that magic set of words that we've talked about so much here on the AMA Update—prior authorization—huge problem and burden on physicians and health care teams alike, a major source of physician burnout. I'd love to hear more from you, Seth, about how this program aims to resolve problems around prior auth, and hopefully, relieve those burdens from physicians. Tell us more.
Gazes: Yeah. So whenever you're designing these types of processes, these centralized processes that are taking a burden off of providers or their staffs, the key is to make it easy for them and simple. And so whether the patient journey begins at discharge or in clinic, we created the easy button for them.
So pharmacy techs or medication access coordinators will work with clinic's providers using various EHR tools to streamline and take full ownership of the prior auth process. But more importantly, they will submit those prior auths. If they need to rework them, they'll rework them. And they'll also wrap around additional laboratory monitoring, clinical pharmacy services and refill management as needed. Once those are completed, 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.
Unger: I really love how the approach that you're taking is really a system-level view of this and all of the pieces and players that are involved. Kristen, what's the way that the pharmacy techs are now able to help physicians?
Kruszewski: So our pharmacy techs are really driving a lot of this. And we've expanded them to do a number of other things. So they're the ones that are the person who is going to take the initial call from the patient. So they're the ones that are actually taking the call.
And then they triage it to the pharmacist if it needs to. But then they also will manage those medication-related needs that have to usually happen inside the clinic. So 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. And so looking at that from a global perspective is really let us drive forward with a number of these initiatives.
Unger: Really smart. I have a feeling I know the answer to this particular question, but Jerry, you can let us know. What's the feedback been from physicians on this program? And what are the kind of early results that you can share?
Greskovic: Yeah, yeah. Shockingly, they like it. Who would have thunk if you took something off them that they didn't like very well and do very well, that somebody would be happy. But yeah, initially started off in a couple small clinics targeting the population, thinking would take us a few years to ramp it up. It didn't take long.
Once the physicians heard about it, heard about the successes, they started reaching out. When can my clinic get it? When can we expand it globally? Today, 90,000 authorizations a year go through this team. So you can imagine the workload that that's taken off our clinic staff, our doctors, our nurses.
Preliminary data—we improved the turnaround time by about two days. Our prior authorization acceptance rate is about 34% higher than when the clinics were doing it. I think if you look back at time studies, there's probably about a three or four hour savings in time now for that staff that was doing it previously, and that's per week. So three to four hours of clinic and nurse staff every week that were given back to the clinics.
I think the last thing—and probably it goes undersold when you talk about it. We took away a lot of that back and forth. When you have pharmacists, pharmacy techs up front, they can resolve a lot of issues before it gets that far. So we're not going back and forth four times with the payer. We know immediately. It's either covered. It's not covered. If it's not covered, Todd, let's switch it to a drug that is. Let me help you figure out what that looks like.
Unger: That's fantastic news, and what terrific results. I'm sure everyone really misses the old way and all that back and forth that you're talking about. Seth, I'm curious, a program like this and everything that you're doing right now, not easy to pull off. Tell us a little bit more about what you faced in making the program a reality. Any kind of big challenges for folks that might want to emulate something like this?
Gazes: Yeah. I mean, the first thing we had to do was really understand what the volume of prior authorization workout there was. So we knew what size operation we would need to centralize and what that process would look like.
And the second thing we really wanted to understand is what that burden was on the staff so we knew what impact it would have. And once we had those two pieces of information, we developed our staffing plan. We developed our phased rollout plan by region, by clinical specialty. Certain specialties, were going to have more of an opportunity than others.
And we trained staff, developed the resources to roll that out. We took a very agile approach. We got feedback from those first several clinics. And as Jerry mentioned, once the word got out, and we were able to work through some initial issues through our workflow, there was really a buzz on the street about, when can I go next? When is it my turn? And it really just generated a lot of momentum for the program.
Unger: Well, speaking of that, Kristen, are there discussions about expanding the program in the future?
Kruszewski: We've been expanding it over and over. For example, we started with a lot of the retail support. But we've even branched out into patient financial assistance because we know that cost of medications is one of the hardest things for many of our patients. And in 2023, we connected over 4,000 patients to our financial assistance program.
We're working to even expand the program to cover all points of entry for the medication and prior authorization requests—so whether it's a fax, a phone call, an email—and developing that real PA and patient support from the moment the patient actually reaches the hospital all the way through discharge and then following up. Because we want to keep them out of the hospital. And if we can help in any way, it's a benefit for not just our health system, but also for the patient overall.
Unger: That's a really important point. And that's a theme I was going to bring out at the end, but since you said it, boy, these changes really—I mean, you think about the double benefit to the patient. It's faster. It's more efficient, less frustrating, and similar benefits for the physicians and the rest of the care team. Kristen, if you were giving any advice to other health systems who might want to implement a program like this, you have any tips?
Kruszewski: Yeah. I think the first thing is you want to define your internal problem or problems. I mean, at Geisinger, we needed to address a bunch of them. So we had physician burnout, provider shortages, time demands on the clinic and nursing staff, and delays in care. But defining those initially provides you with objective metrics to show the value of the service once implemented. And that's really, really important when you're going to start off with anything else.
And then the next step is really, what is the area that the greatest value can be obtained? Maybe there's an area in your practice that really struggles with one of these or all of them. So let's go ahead and focus on them and provide a solution where they can then build.
And we found that using that combination of pharmacists to manage that flow side and the pharmacy technicians to manage that operational side has really solved those challenges for the physician practice. As we define our roadmap, that's going to be really important because we're not going to be able to do everything all at once. We know that.
So really, we want to prioritize the biggest challenge and then optimize in the future. That building will then show not only to your patients, but also your providers, that you're willing to continue to move forward as the landscape changes.
And lastly, it's really important to share the success under those defined metrics. Because, as Jerry mentioned, not everybody was chomping at the bit from day one. But as soon as they heard how successful it was, they want more and more people to be a part of this. And so understanding the why at the beginning and having those metrics really lends to a full-fledged solution.
Unger: Yeah. People always forget about that part of telling everybody else how successful it is. And then you're like, why did we continue to do it the old way when there's such a better way in process right now?
This has been a really inspiring story. I love the teamwork and the innovation here for both patients and physicians. Kristen, Seth, Jerry, thanks so much for joining us and telling us about your work.
If you found this discussion valuable, you can support more programming like it by becoming an AMA member at ama-assn.org/join. That wraps up today's episode. We'll be back with another AMA Update. Be sure to subscribe for new episodes and find all our videos and podcasts at ama-assn.org/podcasts. Thanks for joining us today. Please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.
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