Training to become a doctor is notoriously grueling. Yet despite the thousands of hours of education, there’s one topic that’s not often taught: how to navigate insurer’s utilization management tactics.
The catchall term encompasses a suite of restrictions used to limit patients’ access to treatment. While the barriers aren’t new, there is renewed enthusiasm for training the nation’s newest doctors on how to overcome them.
A Complex Health System
Medical students and residents are being sent “into the field unprepared to grapple with the dysfunctional, complex health system we have bequeathed them,” Rusha Modi wrote in a piece titled, “Med schools are failing to teach doctors the basics of health policy.”
The American Medical Association also pointed out that medical training includes “little or no emphasis” on health care policy and economics, yet they are topics just as relevant as physiology and pharmacology for practicing medicine today.
Barriers Test Patients and Providers
While all health care providers face these barriers, it can be useful to look at how they impact one specialty. Dermatology residents are on the front line of the administrative deluge.
One in four Americans will require care for one of the 3,000 diseases dermatologists treat. Many of those patients will be battling not just psoriasis or skin cancer, but also complex eligibility requirements and coverage schemes for their medications. Access barriers like step therapy, when a patient is forced to try and fail on one medication before gaining access to their physician-preferred treatment, can make coping with their condition worse.
The barriers are also more than a minor annoyance to health care providers and their office personnel.
From a resourcing standpoint, one dermatology practice reported a quarter of all staff communications were related to the processing of prior authorizations. The burden is so frustrating that one provider intended to retire rather than continue committing so much of his time to work that has no benefit, and often great cost, for patients.
Until System Reforms, Skills Training
Addressing the paperwork burden so doctors aren’t driven from the profession requires a multi-pronged approach.
Commonsense insurance reforms are needed, as are more transparency and accountability for pharmacy benefit managers. In the meantime, equipping newly minted doctors to skillfully navigate insurers’ complex processes can help to minimize patients’ delays in accessing treatments and, hopefully, reduce their frustration.
