Patient access and reimbursement is a unique role as it functions between patients, providers, and payers. Being able to navigate the payer policies and get patients access to much needed therapy comes with valuable knowledge.

As reimbursement and patient access does right by patients, there are lessons to be learned and shared with the rest of the industry. Focusing on these key lessons will ensure your access and reimbursement team thrives.

1. Being proactive

Whether it is patient-specific or health system wide, being proactive is where healthcare is going. We see that retrospective processes are taking up a lot of time for providers, health systems, and patients. But these processes also cost everyone a lot of money.

Preventative medicine and quality based systems are happening. They are expected to be the standard in a few short years. Especially now that the pandemic brings comorbidities and the concept of “high risk” to daily mainstream media.

This proactive approach saves the entire healthcare industry billions of dollars. By practicing preventative medicine, we will see fewer patients needing hospitalizations to manage their conditions. Also, it is likely that fewer patients will experience chronic disease and a larger percentage of the population will live healthier lifestyles.

In access and reimbursement, being proactive means knowing the provider policies early and processing claims correctly the first time. Policies change frequently and informing the stakeholders early leads to greater success.

2. Collaboration is Key

The healthcare landscape is evolving to include more collaboration. Being proactive requires collaboration across disease state specialties and disciplines in healthcare. Interdisciplinary collaboration of healthcare providers is becoming standard. The typical healthcare team consists of physicians, nurses, medical assistants, physician assistants, pharmacists, respiratory therapists, and so many more. This is to have each person bring their expertise to patient care.

This is no different for patient access and reimbursement. There are professionals that dedicate their careers to understanding billing, coding, and reimbursement. Centralized authorization departments can expedite the prior authorization and claim processing process. Physicians and nurses don’t have to learn how to navigate payer requirements when there are experts focused on just that.

Collaboration is also seen with professions in pharma. Support is the main purpose of reimbursement and patient access teams. The healthcare team can use them for support on the latest changes to payer policy. When working for patient access, no one works alone.

3. Lifelong Learning

We all know that the industry changes every six month. Do we expect access and reimbursement to stay stagnant? No. We need to adapt with the changes.

Access and reimbursement is inherently about adapting to change and critical thinking. This is achieved through career development and learning opportunities. Opportunities to learn happen in everyday conversations, webinars, and even Clubhouse chat rooms. Every experience is a learning opportunity. But if you find yourself thinking about how you can learn more and do more for patients – it may be a good idea to pursue recognized programs, like the Prior Authorization Certified Specialist (PACS) program. Dedicating time to understanding the payer landscape and prior authorization at your own pace will take you to the next level.

4. What’s Easy isn’t Always Right

Patient access and reimbursement roles support patients and their providers in getting the best outcomes. In this area of healthcare, there is a lot of pushback to getting the right treatment to the right patient. Often, providers will decide to go with a medication that may not have a prior authorization or not have as many step therapy requirements.

But does that make it right? No. It was the easy thing to do. If through joint decision making the provider and the patient decides that a specific treatment option would be a great next step in their health journey, they should be able to move forward.

Unfortunately, that isn’t always the case. Patients are often advocating for themselves and trying to do what’s right for them in a system built with too many obstacles. That doesn’t mean they have to go through the obstacle course alone.

Do what is right, not what is easy.

The National Board of Prior Authorization Specialists (NBPAS) is an ACMA company which focuses on setting benchmarks of excellence for the life sciences and healthcare industries. We specialize in empowering professionals to enhance patient access and reimbursement. Reducing denials and saving time and money when dealing with payer policies is a bonus.