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Medical Society of Delaware working to streamline prior authorization

Vincent Albanese, CEO and Founder, Haven Health Solutions;Mark Thompson, MHSA, Executive Director of the Medical Society of Delaware; and Mark Jacobs, MHA, CIO, Delaware Delaware Health Information Network

A group of First State medical professionals is working to expedite the process by which patients get approval for medical procedures.

Many procedures physicians perform require prior authorization from insurance companies. This is meant to protect patients from fraud and abuse, but requires paperwork and can take a couple days to process.

Mark Jacobs is the Chief Information Officer for the Delaware Health Information Network, or DHIN.

“A lot of these are approved by physicians getting on the phone and sometimes screaming at the health plans,” said Jacobs.

Jacobs and others with the Medical Society of Delaware are working on a new system called the Smart Prior Authorization Project. The plan is to bring payers and providers together to try to streamline the prior authorization process utilizing blockchain technology to access medical data already stored by DHIN.

Co-founder and CEO of the Delaware-based Haven Health Solutions Vince Albanese is also working on the project.

“The system will say automatically, ‘That procedure requires prior auth and you’ve done such a good job, or you’re in a risk-based contract, we’re going to automatically approve it instantly,’” said Albanese. “And it lets everybody know that event has occurred so there’s an audit drill.”

The Smart Prior Authorization Project will exempt physicians who’ve proven themselves able to perform a procedure from needing prior authorization for that procedure. And patients will no longer be required to get authorization for recurring medical events previously approved.

Jacobs and Albanese each say this model is gaining traction at medical societies across the country.