It’s kind of a vicious cycle. Payers don’t trust providers to do the right thing and provide appropriate care. And OK, there’s some logic there considering that 25-ish% of health care delivered is low-value or unnecessary. On the other hand, some patients actually need the care and now it’s painstaking for them to get it—and that painstaking part of the sentence is borne by providers, at least logistically. So then the providers learn how to expedite getting their patients care by copying and pasting, and now they’re gaming the system. Then more arduous processes get put in place, and now good physicians get caught in the same net as the less good ones and they begin to spiral toward moral injury and burnout.
Let’s get to the bottom of this. In this health care podcast, I speak with Ron Wince, CEO of Myndshft.
You can learn more at myndshft.com or follow Ron on Twitter at @RWince.
Ron Wince is founder and CEO of Myndshft Technologies in Mesa, Arizona. An engineer by training, he has two decades of experience automating and optimizing time-consuming health care administrative tasks and has held executive positions at leading financial, manufacturing, outsourcing, and customer experience companies. Ron created Myndshft with a singular but ambitious goal: to fix the “administrative plumbing” that keeps health care stuck in the past. They are working at the intersection of blockchain and artificial intelligence (AI). Through CognitiveBus, a first-of-its-kind cognitive blockchain platform, Myndshft Technologies is simplifying enterprise-grade AI and unlocking the insights hidden in the massive and growing data universe.
01:29 What is a prior authorization?
02:45 The three reasons payers put prior authorization in place.
02:49 Cost, medical necessity, and compliance.
04:24 EP200 with Stacey Worthy.
05:15 “Clinicians are really managing clinicians in a lot of ways.”
05:41 Why the prior authorizations system sometimes fails patients and payers.
08:13 Surprise care—can it be avoided?
09:53 The impact on providers.
14:52 The impact on patients.
16:46 Specialty pharmacy and prior authorizations.
18:43 Shkreli Awards (EP260).
19:25 The most complex prior authorizations.
21:03 E-prior authorizations.
24:19 Gold carding and what that is within prior authorizations.
28:08 The “chasm of trust.”
29:11 Myndshft and its goal to solve prior authorization issues.