Prior Authorization Gold Card Pilot case study
Value-Based Care Case Studies
Abstract
This case study explores a four-year pilot program between Asheville Neurology Specialists and a local South Carolina payer to streamline the prior authorization (PA) process for toxin injections used in treating migraines and headaches. The goal was to reduce administrative burdens, improve healthcare quality, and decrease costs. Asheville Neurology followed insurance policies and completed a Toxin Attestation Fax Form for efficient authorization. The pilot resulted in improved collaboration between the practice and payer, reduced administrative work, and better patient access to treatment. The pilot also highlighted the potential of Gold Card programs, which exempt providers with consistent approval rates from PAs, and are being adopted by other states and insurers.
Introduction
Prior authorization continues to be an area of burden for many practices and physicians. Asheville Neurology Specialists worked with a local payer to pilot and expedite the prior authorization (PA) process for toxin administration for migraine/headache patients. This case study examines a prior authorization Gold Card pilot program to reduce the prior authorization burden, and conducted over four years.
The AAN’s Care Delivery Subcommittee, under the guidance of the Medical Economics and Practice Committee, set out to better understand different care delivery models, their core functions and features, and the professional and personal advantages and disadvantages of such models compared to traditional fee-for-service care delivery and reimbursement. To better understand using a Gold Card program, the Care Delivery Subcommittee worked with Business Administrator member Carolyn M. Chamberlain, CMPE, CEO of Asheville Neurology Specialists, to provide insight into a Gold Card pilot with a local payer. Responses below represent the individual experiences of the contributors and are not the official opinion of the AAN or Asheville Neurology Specialists. Responses below represent the individual experiences of the contributors and are not the official opinion of the AAN.
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