Insufficient Access Threatens Patient Health
Access to care is often described as a patient’s ability to obtain necessary medical treatment and is influenced by factors such as adequate coverage, affordability, and convenience. Unfortunately, if one of these primary factors is missing, many patients skip receiving care altogether and put their own health at risk.
With the percentage of Americans having health insurance surpassing 90% in recent years, access is now more dependent on a patient’s ability to afford their care and find options that are convenient to them. This is no easy feat however, since understanding healthcare costs and covered services can be extremely difficult for the average patient. Unfortunately, primary care providers have also found it difficult to support each of their patients because of the complexity of patient coverage, which can greatly impact the care they can afford and where they can receive it.
Access is undoubtedly shifting from a patient problem to a provider responsibility. As such, we must arm providers with crucial data and tools so that they can have better conversations at the point of care — conversations that are specific to each patient, can improve health outcomes, and can reduce unnecessary costs. If we cannot better manage access, even for covered Americans, we may face a continuous cycle of non-compliance and ineffective care.
Redefining Access to Care
Access to care has historically been reliant on a patient obtaining insurance coverage and finding a provider that is a participant in the insurer’s network. Instead, we must think about access from a broader perspective since common hurdles often manifest within provider workflows. For instance, friction arises when providers cannot view reliable and patient-specific coverage information when care is being delivered. Additionally, prior authorization volumes burden care teams and delay (or even prevent) care altogether.
These factors impact a patient’s ability to obtain care, even though the patient has no opportunity to influence them. Each decision a provider makes can greatly influence the effectiveness of the care plan. Therefore, access to care can no longer solely be a patient problem. Provider organizations — and the technologies they use — play an essential role in a patient’s ability to access care.
The Solution: Enable Better Decisions With Point-of-Care Tools
Since patients nearly always rely on their providers for complex care decisions, we must work to bring meaningful data into care workflows — not just present it in patient and provider portals. Survey results show that nearly 90% of physicians want better coverage and cost information at the point of care, and more than 72% don’t engage with patients about care costs. By integrating data feeds that include patient-specific cost and coverage information, providers can consider the impact they are having on patient access, as well as the benefits they may realize for the system.
For example, an asthmatic patient may require a prescription for an inhaler and may need to see a specialist for their chronic condition. Instead of prescribing the most common inhaler on the market, with meaningful data presented in the EHR, a provider can see lower-cost, covered inhaler alternatives and offer a specialist that is in-network — improving care continuity, patient experience, and affordability, all while reducing system leakage.
Just as important, as health systems take on risk and manage the total cost of patient care, it is essential that they implement tools to reduce costs, while improving care compliance and outcomes. Integrated solutions can deliver these benefits, while allowing health systems to effectively measure care variability and opportunities for behavior change.
Supporting Providers With Integrated Data
RxRevu has developed a suite of solutions that deliver the most accurate patient coverage and cost data directly to care workflows. With this data at their fingertips, providers can have informed conversations with patients about coverage, affordability, and convenience. RxRevu works with the nation’s leading payers, providers, and EHR vendors to solve care access challenges at the point of care, clearing the way for better health in every patient encounter. To learn more about how RxRevu’s integrated solutions are improving patient access to care, please visit RxRevu.com.
Kyle Kiser is Chief Executive Officer at RxRevu, where he has built the nation's largest cost transparency network between payers, providers, PBMs, and EHR vendors. Kyle spearheads projects to improve patient access, reduce care costs, and streamline provider workflows.