Blue Cross Blue Shield of MA, aligning with other major payers, abolished 14,000 home healthcare-related prior authorizations, effective Jan 1, 2024. This move aims to expedite hospital discharges, ease capacity strain, and enhance patient transitions to home care. Driven by collaboration with clinical partners, it’s part of Blue Cross’s wider strategy to minimize prior authorizations. Despite the change, they acknowledge the importance of these authorizations in ensuring efficient, quality healthcare.
Blue Cross Blue Shield of Massachusetts (Blue Cross) has made substantial strides in improving access to healthcare services by eliminating a significant number of prior authorizations, aligning with a collective movement among major payers. This strategic decision, taken between August and November 2023, reflects a joint effort among prominent entities like Blue Cross, Cigna, and UnitedHealthcare to facilitate quicker access to care while easing the administrative burden on healthcare providers.
Blue Cross, as the latest contributor to this initiative, has eradicated 14,000 prior authorizations concerning home healthcare for members covered under its commercial health plans. This pivotal change, effective from January 1, 2024, particularly impacts prior authorizations for services such as physical therapy, occupational therapy, and home visits by healthcare aides, nurses, and social workers.
Dr. Sandhya Rao, Blue Cross’s Chief Medical Officer, delineated the dual objectives steering this policy shift in an interview with HealthPayerIntelligence. The primary goal is to alleviate strain on overcrowded hospitals by expediting discharges, thereby freeing up vital space within healthcare systems. Additionally, this change seeks to ensure smoother transitions for patients from hospitals to their home environments, recognizing the preference of many patients to recuperate in familiar surroundings with their families.
A critical aspect contributing to the success of this initiative has been the collaboration with clinical partners, aiming to alleviate administrative burdens on providers and streamline the care delivery process.
This strategic maneuver by Blue Cross forms part of an ongoing endeavor to enhance the prior authorization process. Preceding this shift, the payer had already removed prior authorizations for various essential medical requirements, including Type 1 diabetes supplies, continuous glucose monitoring devices, outpatient mental health treatments, and emergency department transfers to inpatient mental health stays.
Moreover, the implementation of automated prior authorizations through the Fast Pass proof-of-concept pilot significantly slashed approval times, underscoring Blue Cross’s dedication to streamlining this process.
Acknowledging the pivotal role of prior authorizations in evaluating the necessity and appropriateness of medical treatments, services, and devices, Blue Cross emphasizes their importance in ensuring improved health outcomes and cost-effective care for its members.
While continuous efforts are underway to further refine the process, Blue Cross remains receptive to guidance from government entities. The evolving healthcare landscape has witnessed other payers adopting alternative approval methods and harnessing advanced technologies to expedite prior authorization procedures.
Blue Cross’s proactive stance in eliminating prior authorizations for various services, coupled with their commitment to improving the efficiency of the healthcare system, signifies a step toward accessible and streamlined care for its members.