New study analyzes differences in characteristics between beneficiaries as they're transitioning from commercial to Medicare coverage at 65.
MA enrollees have less money and are more susceptible to social risk factors than traditional Medicare members, according to a new white paper by Harvard Medical School and Inovalon.
The study attempted to examine the factors that influence enrollment in MA or fee-for-service (FFS) Medicare at the critical point when beneficiaries are transitioning from commercial to Medicare coverage at the age of 65.
Researchers utilized Inovalon's dataset, which accounts for approximately 30% of the privately-insured population in a given year, as well as a CMS dataset containing the medical and pharmacy insurance claims for all Medicare beneficiaries enrolled in FFS and enrollment data covering all Medicare beneficiaries enrolled in FFS and MA. The third dataset used was Acxiom's files that track social determinants of health (SDOH).
The sample of beneficiaries included those who turned 65 between 2015 and 2019, were enrolled in Medicare within three months of turning 65, were in the same plan for at least 12 months, were not also enrolled in Medicaid or a commercial plan at the same time, and were enrolled in an employer-sponsored health plan for all 12 months before turning 65. With those limitations, the final sample consisted of 180,087 enrollees in FFS and 25,470 beneficiaries in MA at age 65.
What the study uncovered was significant differences in socioeconomic characteristics between MA and Medicare enrollees. The average income of Medicare enrollees was found to be $85,085, compared to $76,720 for those in MA. When it came to net worth, MA enrollees were 74.2% of the average of Medicare enrollees. The divide was consistent with the difference in location—35.5% of Medicare enrollees live in a neighborhood with incomes above $100,000, while that's the case for only 23.8% of MA enrollees.
Further findings included that MA enrollees are twice as likely to be non-white and much more likely to be Black, Hispanic, or Asian. Meanwhile, MA enrollees were 50% more likely to have been enrolled in an HMO plan right before turning 65.
"Historically, it has been challenging to document differences in beneficiaries who enroll in Medicare Advantage versus traditional Medicare at age 65," Christie Teigland, vice president of Research Science and Advanced Analytics at Inovalon, said in a press release. "Our study provides a better understanding of the core customer segments of Medicare Advantage and which beneficiaries are most likely to enroll in which coverage type. This information can help health plans better tailor and target their products to enhance member recruitment and retention and better plan for future resource needs."
As MA continues to grow and overtake Medicare as the primary plan choice for seniors, it's necessary for lawmakers to better understand the MA population to ensure the private program is serving beneficiaries the best it can.
Michael Chernew, health economist and professor at Harvard Medical School and overseer of the study, said: "The findings provide new resources for policymakers and healthcare administrators to improve the delivery of value-based care programs, address health inequities, and improve health outcomes for all beneficiaries."
That's what Interwell is striving for by setting the standard in value-based kidney care through its network of physicians and strategic partnerships, including Providence Health Plan and Oak Street Health.
Sepucha recently joined the HealthLeaders podcast to detail how the kidney care management company is serving an in-need population and furthering value-based care efforts, as well as offering insight into where value-based care is heading and how payers and providers can find middle ground on payment models.
This transcript has been edited for clarity and brevity.
HealthLeaders: Can you tell me about the value-based model Interwell Health uses and how that was identified?
Sepucha: There's long been a desire to move upstream to identify patients earlier and to engage in their care. That fundamentally is what Interwell Health is all about. So if you start with that as the fundamental precept of designing the ideal value-based care model for kidney patients, what that requires then is a multi-model approach to engage patients. We believe that the physician has to be the center point of that. We at Interwell have our own clinicians. We engage directly with patients, with nurses, dieticians, and social workers, but we also exist to support the independent practicing physician. For us, it's about supporting the patient, helping them engage them in their own care, and to do that, you have to be able to touch them where and when they need it most.
HL: How has the partnership with Providence Health Plan been vital to the value-based care effort?
Sepucha: We partner with large networks of nephrologists by making sure that they have the same economic interest as we do so we share savings with the physicians. By working together, if we're able to improve the health outcomes for our patients, as well as drive down costs, then we collectively share in that. The relationship with Providence is exactly like this. And the fun thing for me is there are different pairs across the country, all approaching the problem in slightly different ways, all with different needs for their own geographies and membership. So we're able to be very creative in how we contract with our plans, whether that's Providence or some of the national players. We can take absolute full risk and sub-capitated arrangement or do a shared savings arrangement. There's a bunch of different ways we can contract all to try and make this as easy as possible for payers to finally give their kidney membership access to the merits and benefits of value-based care.
Bobby Sepucha, CEO, Interwell Health.
HL: What has the partnership with Oak Street Health achieved in terms of expanding primary care?
Sepucha: Our collaboration with Oak Street to create this new joint venture called OakWell, for us is really the next foray and the future in vanguard of where kidney care is going to go. We're going to start out small. We're going to start in a few markets and bring Oak Street primary care docs into the dialysis clinic and have them round with our patients. Over time, the idea is to then go upstream so that we at Interwell and nephrology partners can be kind of the kidney care extenders for the primary care patients who are perhaps earlier stage in their in their progression of kidney care.
If you take a big step back, the advent of value-based care across primary care and across all these specialties is unbelievably exciting. It's one of the most exciting things to happen in American healthcare in decades. But I think we all have an obligation that if we are not able to figure out how to coordinate, then we risk sort of reinforcing the siloization of healthcare. And that of course would be a massive opportunity missed.
HL: How do view the landscape right now for value-based care and where do you see it going both in the short and long term?
Sepucha: Kidney care is still very much in the nascent stages of moving towards value. If you put a calendar on it, I'd say we're probably five to seven years behind primary care in terms of moving towards real fulsome risk. But the pace of change here is rapidly accelerating and all those plans who used to focus on dialysis rate are now pushing Interwell and other providers into more fulsome risk, sub-capitated risk, which is terrific. That's the exact right thing to do.
I think the biggest challenge for us as a society and a system is ensuring that we don't do these things independently. I joke around, but it's only half-joking, I think one of the worst places in the world is being at a health plan and trying to make sense of all these different point solutions that they've signed up in the last several years. How do you make them all talk to each other? I think that's the next stage of where this needs to go in terms of making this all work more effectively and more efficiently.
HL: What kind of approach or mindset does it take for providers and payers to find that sweet spot of a payment model?
Sepucha: Mindset is actually a great way of framing it. It's working in collaboration and viewing this as a partnership. We are not at the point, nor can I imagine getting to a point in the near term of walking into a health plan and saying, 'Here's the off-the-shelf contract, sign here.' This is a consultative arrangement. This is trying to understand what this specific population that this health plan is serving. What are their challenges? How has the plan been managing this population, if it's been managing it at all? For a lot of these plans, it's not about making a profit, it's about losing less money. That's a really important distinction. For us, it's about understanding where the plans are. It's is about understanding the unique characteristics of the geography that we're going to serve, the systems that are in place, the healthcare systems that are caring for these patients. Because if you don't understand that at the outset, you're going to fail.
HL: What are some of the financial or operational challenges that you're experiencing right now and what are some strategies that you're using to address them?
Sepucha: Through the lens of labor, a lot of ink has been spilled and a lot of people have talked about the labor shortage that's plagued American healthcare particularly, with respect to skilled nursing. We've had the good fortune of having an awful lot of candidates, incredibly impressive, high-quality candidates apply. But then you have to help them understand what this new clinical model is like, how to engage patients differently, how to engage physician practices differently. And that just requires an awful lot of change management. For us, it's basic operational blocking and tackling. It's making sure we have the clinicians in place, making sure they're trained staff and ready to go, making sure they understand the unique aspects of the geography and the patients they're serving. That's our laser focus because it begins and ends for us in terms of how you engage the patients.
The proposed rule by CMS is the remedy to payment rates the Supreme Court deemed unlawful.
CMS announced it will pay eligible hospitals $9 billion in a lump sum payment under a proposed remedy for the 340B payment rates—a decision hospital groups expressed satisfaction with.
The federal agency estimates that from 2018 through approximately the third quarter of 2022, certain 340B providers received $10.5 billion less in 340B drug payments than they would have without the policy.
In June 2022, the Supreme Court unanimously ruled against the 340B payment rates, considering them unlawful because HHS failed to conduct survey of hospitals' acquisition costs.
However, CMS stated that affected 340B providers have already received from Medicare and beneficiaries $1.5 billion of the $10.5 billion that would otherwise be owed. The remaining $9 billion for claims will go to 340B hospitals that were paid less due to the policy.
The American Hospital Association (AHA) said it was "extremely pleased" with the remedy.
Rick Pollack, AHA president and CEO, said in a statement: "We are especially gratified that HHS agreed with the AHA's position that these hospitals must be promptly repaid in full with a single lump-sum. At the same time, the AHA is disappointed that HHS has chosen to recoup funds from other hospitals that cannot afford additional Medicare payment cuts, including rural sole community, cancer and children’s hospitals that were initially exempted from HHS' illegal policy. We will continue to review the proposal closely and look forward to providing comments."
Meanwhile, America's Essential Hospitals also voiced their satisfaction with the proposal, but took issue with the budget neutrality portion of the rule.
Bruce Siegel, president and CEO of America's Essential Hospitals, said in a statement: "Essential hospitals still face heavy financial pressures from high labor costs and other challenges from the pandemic, and these payments are urgently needed to help these hospitals meet the needs of their patients and communities. We urge the Centers for Medicare & Medicaid Services to expedite the release of the reimbursements.
"We are disappointed the remedy payments would include no interest and be budget neutral. The administration’s plan to cut non–drug payments to hospitals to achieve budget neutrality unnecessarily blunts the impact of the remedy by ensuring years of future underpayments."
New research adds to the concern over quality improvement in the private program.
Rather than informing beneficiaries or encouraging Medicare Advantage (MA) organizations to improve quality, the quality bonus program (QBP) is significantly contributing to overpayment in the MA system, according to a report by the Urban Institute.
The QBP was established by the Affordable Care Act as part of several MA reforms that were meant to reduce payments to MAOs, but lawmakers have expressed concern that the program is doing the opposite.
For the report, researchers analyzed the 2023 MA star ratings data and related MA enrollment data to better understand the QBP's role in the MA payment system and how star ratings are scored.
The findings show that, after weighting, about two-thirds of a contract's star rating is determined by beneficiary experience with care and MA administrative effectiveness. However, measures of beneficiary experiences do not allow for meaningful distinctions across MA contracts and administrative effectiveness measures do not target important deficiencies.
Further, the star rating system and QBP suffered from issues such as score inflation resulting in overly generous bonuses, limitations in underlying data sets that don't allow for measures focused on beneficiaries with serious illness, and performance that is not measured at the plan or local level.
"In short, the QBP is a windfall for insurers that does not provide valuable information to beneficiaries or protect them from poor performance," the report stated.
MedPAC, which has been vocal about the QBP being flawed, suggested a replacement for the program that would rely on a small set of population health measures to determine MA plan quality at the local level, as well as assess rewards and penalties to make it budget neutral.
Urban Institute researchers feel the replacement has merit, but stated that reforms should focus on protecting beneficiaries from poor plan administration.
"Problems with MA contract administration are well documented, and CMS could drive real improvement in beneficiaries' access to care under MA with a system of rewards and penalties focused on areas of concern like network adequacy, access to postacute care, prior authorization denials, disenrollment among high-need beneficiaries, and serious illness care," the report said.
Additionally, researchers posit that reforms focusing on performance should allow for exceptional MA contracts to receive bonuses and serve as models for other MAOs, while low-performing contracts should be assessed penalties.
"The effectiveness and excessive rewards of the MA QBP should be part of ongoing discussions to improve the longevity of the Medicare trust fund," the report concluded.
The payer giant is once again facing a dispute over reimbursement issues, this time from Howard Memorial Hospital.
Payer-provider relationships are already strained from the financial pressures coming out of the pandemic. What won't help the cause is the nation's largest health insurer allegedly failing to properly pay a small, nonprofit hospital.
Arkansas-based Howard Memorial Hospital has filed a complaint against UnitedHealthcare's Medicare Advantage program, claiming the insurer underpaid based on their contract, Southwest Arkansas Radio reported.
The hospital's CFO, Bill Craig, alleges that, according to the 31 accounts he analyzed, UnitedHealthcare underpaid by $250,000. Craig also said he's been working with the payer for approximately six months via email and UnitedHealthcare realizes they have been underpaying but hasn't resolved the issue.
The report states that the complaint was filed with the Medicare Part D complaint division on June 12 and that Craig said he would give the division about 45 days before following up and considering further action.
Howard Memorial Hospital's complaint against UnitedHealthcare comes quickly on the heels of another dispute over underpayment the insurer faced in recent months.
In May, UnitedHealthcare was ordered to pay $91.2 million to Envision Healthcare for reducing reimbursement for care provided in 2017 and 2018. An independent three-member panel of the American Arbitration Association ruled that the insurer breached the terms of the contract with the for-profit physician services provider by unilaterally cutting payments for services Envision rendered as an in-network provider.
"This decision sets a critical precedent for insurers like UnitedHealthcare to pay in full for the high-quality care its members receive in their most acute time of need," Jim Rechtin, CEO of Envision, said in a press release. "While we are disappointed that we had to take the step of entering into arbitration to compel UnitedHealthcare to pay its bills, we are satisfied with the panel's decision against UnitedHealthcare and its systematic underpayment to clinicians for the care they provide."
Contract negotiations between payers and providers are already contentious with both sides fighting to claim as much ground as they can.
When one side, particularly the one that often has more leverage, chooses not to honor an agreed-upon contract, it only erodes trust and creates more friction, which ultimately ends up hurting everyone in the healthcare system.
The estimated increase for payers is in both the individual and group market and outpaces projections for 2022 and 2023.
Healthcare costs will swell 7% next year as inflationary pressures impact health insurers' contracts with providers and drug costs continue to rise, according to PwC's annual report.
Researchers surveyed health plans covering 100 million employer-sponsored large and small group members and 10 million Affordable Care Act marketplace members to identify key inflators and deflators in 2024, as well as trends to watch.
The estimated 7% increase in year-over-year healthcare costs for 2024 is higher than the projected costs of 5.5% for 2022 and 6% for 2023.
"The higher medical cost trend in 2024 reflects health plans' modeling for inflationary unit cost impacts with their contracted healthcare providers, as well as persistent double-digit pharmacy trends driven by specialty drugs and the increasing use of certain medications used to treat Type 2 Diabetes or weight loss," the report stated.
The workforce shortage is expected to compound inflationary pressure, with providers continuing to seek higher reimbursement and rate increases from insurers in contract negotiations.
On the opposite end, factors like the shift in sites of care and biosimilar drugs coming to the market are projected to deflate costs.
"With the increased demand for home-based services and virtual care, the healthcare delivery system has reached a new phase," the report said. "Plans are factoring in higher utilization of less expensive care settings and virtual care when pricing their 2023 plans and beyond, helping plans offset the trend inflators."
Researchers also identified six issues that could influence medical costs going forward and are worth paying attention to:
Total cost of care management: This is expected to be deflator on costs as national insurers grow and acquire other plans.
COVID-19: The effect will likely be neutral as health plans did not report higher utilization of care stemming from suppressed demand during the pandemic.
Health equity: As health plans continue to focus on health equity, the short- and long-term effect is yet to be seen on plans' cost of care models.
Behavioral health: Utilization spiked during the pandemic but has since slowed down, with payers not anticipating it as an inflator in the future.
Price transparency rule: The regulation for health plans is still in its infancy after going into effect July 2022.
Medicaid redetermination: Most plans view this as neutral, with the individual market expected to feel the most impact.
The deal will exit Bright Health from the insurance business as it shifts its focus to consumer care.
Molina Healthcare is set to acquire floundering Bright Health Group's Medicare Advantage (MA) business in California in a deal worth approximately $510 million, net of certain tax benefits, the company announced today.
With the sale, which is expected to close in the first quarter of 2024, Bright Health is now completely out of the insurance business and will turn its efforts to its consumer care products, according to a press release put out by the insurer.
Bright Health said it will take the proceeds of the sale to pay off its debts and obligations to benk lenders, with the remaining funds going towards liabilities in its discontinued Affordable Care Act insurance business.
"We are excited to enter into this agreement with Molina as it will allow Brand New Day and Central Health Plan to continue delivering localized, personal care to California consumers and will position Bright Health's Consumer Care Delivery business for long-term success," Mike Mikan, president and CEO of Bright Health, said in a statement. "The sale allows us to focus on driving differentiation and sustainable growth through our Consumer Care Delivery business."
For Molina, the deal gains them Bright Health's Medicare membership of approximately 125,000 enrollees in 23 counties in California, with 60% overlap with Molina's Medicaid footprint.
As part of the purchase, Bright Health will also enter into an agreement with Molina to serve Medicaid and ACA Marketplace members in Florida and Texas in 2024.
Joe Zubretsky, president and CEO of Molina, said in a statement: "These additions fit perfectly with our strategy of serving high-acuity, low-income members and represent a textbook execution of our growth playbook. We acquire viable assets at attractive valuations, then deploy our proven team of operators to deliver improved financial results. We are pleased to continue our meaningful growth in California as the latest realization of our national growth strategy."
AdvancedMD's Amanda Hansen outlines what providers should consider as they pursue partnerships with private equity firms.
The turbulent nature of the current financial climate for private practice owners makes the concept of partnering with a private equity (PE) firm appealing.
Practicing independently can be liberating, but it can also come with burden that is currently being exacerbated by challenges like staffing shortage.
It's no surprise then that there's plenty of activity happening in the PE space as practices explore the possibility of selling and joining a larger group.
"Private equity activity, it can be exciting," says Amanda Hansen, president of cloud medical software company AdvancedMD. "There can be a draw, you can feel like there's going to be good financial payout and reducing that administrative person. But I think doing an honest assessment and making sure that if it is something you're considering that, similar to choosing a new vendor, you would do even more diligence on the PE firm that you're looking at."
For those wanting to take the leap into private equity M&A, Hansen detailed to HealthLeaders the five steps practices should take:
Clean up your KPIs
"The most important thing to help a process go smoothly and help PE firm make an educated informed decision is data," Hansen says. "If you don't measure it, you can't impact it. So make sure as a business you're measuring the right things to help a PE firm or anyone else understands how valuable the business actually is."
Those key performance indicators (KPIs) can be broken up into three different areas:
Clinical outcomes: Measure over time and show improvement in areas like no-show rate, preventative care measures, and patient satisfaction.
Financial health outcomes: On the billing and coding side, look at areas like revenue growth rate, net revenue per visit, operating margin, and collection rate.
Productivity data: Show that the physicians and staff are maximizing their time by measuring aspects like patient visits, average patient wait time, and billing and coding accuracy.
Improve your practice's financial health
Once practices measure their KPIs, it will become easier to see where the gaps and opportunities are to improve financially.
One of those areas of opportunity is often revenue cycle management (RCM). "Practices, providers, and physicians are leaving hundreds of thousands of dollars on the table by having poor revenue cycle management processes," Hansen says.
To improve RCM, practices can make sure they've negotiated favorable rates with payers, as well as making sure they're following up, working denials, and cleaning up denials on the front end.
"A really important one is enhancing your patient experience, which will drive better retention and it will drive more visits and more opportunity in the future," Hansen says.
Audit your workflow processes
Practices can drive efficiency by ensuring they don't have time or resources going unused.
"That can be looking at your operational effectiveness from the registration, from a check-in perspective, documentation," Hansen says. "It's automating administrative tasks that will help improve efficiency for your staff."
This could involve allowing patients to schedule appointments online themselves and making sure your schedule is updated so patients can be called if there are openings. Or it could mean allowing patients to upload their insurance card as part of the registration process so that they don't have to scan every time they go for an appointment.
Embrace innovation
Innovation became even more important during the COVID-19 pandemic, when healthcare still had to happen while everyone was sheltering in place.
That gave rise to telehealth, which went from a secondary option to the primary form of delivery of healthcare.
Being able to maximize value by coming up with and implementing similarly innovative solutions will allow practices to generate the most operating income possible.
"As a practice, it's making sure that you're evaluating what you do have and trying to find the best available out there in order to better position. It just makes the whole business look more attractive when you can do things efficiently and you're doing it with the least expense possible."
Implement the right technology
Finally, practices need to put in place technology that makes the most sense, which can be tricky with the wide range of options available.
Finding the right fit for your practice requires vetting, both of your own processes and of the vendor you're considering. After implementing the technology, practices also need to help staff understand why and how to use the system.
"There's some sort of balance that comes from making smart adjustments to your workflow to meet the system, but also making sure the system is customizable enough that it can also meet the needs of your workflow without having to disrupt your entire business," Hansen says. "So it takes a lot of diligence on the front end and the people that we've seen do that have had a lot of success down the road."
Following these five steps will benefit practices in both the short term and the long run, M&A activity or not.
"It's going to better position you to have a more successful business regardless of whether there's some sort of divestiture involved in that," Hansen says.
Research examines whether financial penalties are a useful policy enforcement mechanism to get hospitals to comply with price transparency regulations.
The answer to the question of what it will take to get more hospitals compliant with the price transparency rule is as simple as increased financial penalties, according to a study published in JAMA Network Open.
Researchers from Georgetown University and Harvard University looked at the responses of 4,377 acute care hospitals operating in 2021 and 2022 to changes in financial penalties by CMS for hospital price transparency regulations.
Financial penalties for noncompliance increased from $300 per day for all hospitals in 2021 to $10 per bed per day, with a minimum of $300 per day for hospitals with no more than 30 beds and a maximum of $5,500 for hospitals with 550 or more beds in 2022.
For the study, hospitals were deemed compliant if they posted a machine-readable file with private, payer-specific negotiated prices at the service-code level.
The analysis uncovered that between 2021 and 2022, compliance rates for the 4,377 hospitals increased by 17.3%, from 70.4% to 87.7%, respectively. Noncompliance rates decreased by more than half, from 29.6% to 12.3%.
According to the researchers, the findings suggest that increasing penalties by another $1.4 million per hospital would increase compliance rates above 95%.
To date, CMS has only hit four hospitalswith fines for not adhering to the rule:
Northside Hospital Atlanta in Georgia, fined $883,180
Northside Hospital Cherokee in Georgia, fined $214,320
Frisbie Memorial Hospital in New Hampshire, fined $102,660
Kell West Regional Hospital in Texas, fined $117,260
In a recent Health Affairsarticle by CMS leaders, the agency said it "plans to take aggressive additional steps to identify and prioritize action against hospitals that have failed entirely to post files."
The article also highlighted that hospital compliance had significantly improved since the agency's first assessment. Between January and February 2021, 66% of hospitals met consumer-friendly display criteria, 30% posted a machine-readable file, and 27% did both. Between September and November 2022, 82% of hospitals posted a consumer-friendly display, 82% posted a machine-readable file, and 70% did both.
For hospitals to be in full compliance, they must have both a machine-readable file with all items and services, as well as a display of shoppable services in a consumer-friendly format.
The Georgetown and Harvard researchers didn't account for the consumer shoppable service tool in their study, which likely led to higher estimations of compliance. However, hospitals have incentive to "quasi-comply" by posting prices that can be difficult to locate, the study noted.
"Quasi-compliance allows hospitals to minimize the costs of disclosing sensitive information while reducing their regulatory risk," the researchers wrote. "Characterizing this quasi-compliance phenomenon is an important direction for future work."
Ultimately, CMS can do its part to boost compliance by enforcing the rule and not letting hospitals skirt regulations.
"Overall, the results of this cohort study suggest that financial penalties may be a valuable tool for ensuring compliance with CMS policy when fines are sufficiently large, noncompliance is readily observable and well defined, and enforcement is credible," the researchers concluded.
Analysis by the American Hospital Association (AHA) reveals hospitals are not near the top of the list of groups acquiring physicians.
Physician acquisition is largely driven by private equity, physician groups, and payers, according to a report published by AHA.
The analysis of Levin Associates data finds that hospitals and health systems are not among the top three groups acquiring physicians since 2019.
Private equity makes up the majority of physician acquisition at 65%, followed by physician groups at 14%, insurers at 11%, and hospitals and health systems at 4%.
Additionally, the data shows that in deals where payers acquire physician practices, the average number of acquired physicians per deal was more than 10 times higher for insurers than for any other acquiring group. To this point, the report highlights acquisitions by CVS Health of Oak Street Health and Signify Health in deals that were valued at nearly $20 billion.
A separate report conducted by Morning Consult on behalf of AHA looked at the factors driving physician practice acquisition. Of the physicians polled, 94% said they believe it has "become more financially and administratively difficult to operate a practice."
Further, 81% said that commercial insurer policies and practices have "interfered with their ability to practice medicine" and 84% reported they have had job interference from commercial payers.
"As physician polling data has shown, most physicians are choosing to become employed rather than operate their own practice due to increased costs and burden from policies like commercial insurer prior authorizations," AHA wrote.
Medicare Advantage specifically has been identified as the most burdensome payer program when it comes to obtaining prior authorization.
A survey by the Medical Group Management Association revealed that 77% of physicians said they have hired or redistributed staff to work on prior authorizations due to an increase in requests, while 60% said there are at least three different employees involved in completing a single prior authorization request.
