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HIA Calls on Congress for Healthcare Interoperability, ePA Legislation

HIA called for policy to support healthcare interoperability through a standards-based, real-time approach to electronic prior authorization (ePA).

With the commencement of the 118th Congress, Healthcare Innovation Alliance (HIA) urged the House and Senate to take action on several issues to improve care delivery, including healthcare interoperability and electronic prior authorization (ePA).

In a letter to congressional leadership, Joel White, HIA executive director, noted that the alliance convened key industry stakeholders to publish an Interoperability Workgroup report in early 2022, which states six critical solutions to improve healthcare interoperability.

“We believe there are tremendous opportunities to ensure that our healthcare system is on the path to being truly interoperable,” White wrote in the letter. “Common sense reforms like having detailed coverage information available at the point of care would ease burdens for both providers and patients while creating more efficiency in delivery.”

“Clinical trials need to be modernized to allow a streamlined, easily understandable authorization process, and patients should be able to participate in trials remotely through secure technology and devices,” White added. “Congress should incentivize interoperability and connectivity in medical devices by establishing an accelerated approval pathway for devices that are truly interoperable.”

HIA also called on Congress to move the needle on ePA.

The alliance worked with Congress to develop and pass into law requirements for the use of ePA for covered medications in the Medicare Part D and Medicare Advantage Prescription Drug spaces as part of the SUPPORT for Patients and Communities Act in 2018.

“This was a critical first step to streamlining prior authorizations (PA), reducing friction in the system, alleviating burden for providers, and improving the timeliness of access to necessary therapy for patients,” White wrote.

“Streamlining and digitizing PA processes in other programs will ensure more patients receive the same benefits,” he continued. “Switching from more traditional PA processes to real-time ePA could result in $437 million in savings and give providers 16 minutes of their time back for each transaction.”

Decreasing clinician burden while improving consistency for payers will result in better care for patients and savings for the healthcare system, HIA emphasized.

“Last Congress, we watched closely the advancement of the Improving Seniors’ Timely Access to Care Act, H.R. 3173, culminating in passage by the House,” White wrote. “We understand the concerns raised by the Congressional Budget Office’s estimate that H.R. 3173 would raise costs by $16.2 billion over 10 years due to increased services and the cost of technology adoption.”

“With the release of the proposed rule on ePA for medical services by CMS in December 2022, that score should now be much lower,” he said. “Given the negligible score of the 2018 policy for drugs, we urge you to consider standardizing ePA for drugs as well as items and services to ensure patients have access to both the medications and services they need.”

HIA called for legislation implementing a standards-based, real-time approach to ePA to achieve seamless exchange across the care continuum for improved patient care.

Next Steps

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