Prior Authorization Managers, Care Management Homes Could Expedite IBD Care

Amy Stewart, NP

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Teams comprised of prior authorization coordinators may have an advantage in getting patients on advanced therapy for inflammatory bowel disease (IBD) sooner, and chronic home care management may also help expedite drug start time for such patients as well, according to findings from recent research.

A poster presented at the American College of Gastroenterology (ACG) 2024 Scientific Sessions in Philadelphia, PA, this week showed, despite setbacks in due to insurance appeals and other payor requirements, a handful of practice-related strategies and staffing decisions may help make the pipeline to IBD pharmacotherapy more efficient for care centers.

Led by Amy Stewart, NP, of Capital Digestive Care in Washington, DC, the trial sought to determine factors impacting the mean approval time and time to first dose for patients seeking care for their IBD.

“Current guidelines recommend initiation of advanced therapies in patients with moderate to severe inflammatory bowel disease,” they wrote. “The insurance approval process carries a very high administrative burden that puts strain on medical practices and affects patient outcomes.”

Stewart and colleagues conducted a retrospective review of all new biologic starts within their 28-provider, community-based practice in 2023. Their data for assessment included patient demographics, disease history, insurance information and appeals processes. Descriptive statistics were used to calculate mean days to insurance approval and drug starts; differences in mean times between those requiring an insurance appeal for their treatment were described via Kaplan Meier and log rank tests.

The final analysis included 233 patients; 86% were White and two-thirds (63.4%) were female. Mean time to insurance approval for IBD treatment was 4.03 days, while mean time to treatment initiation was just over 2 weeks (14.17 days). Time to approval was 19.31 days for patients who required an insurance appeal—more than 6-fold longer than patients who did not require any appeal (3.09; P <.001).

Investigators observed no significant association between time to treatment approval and each of disease diagnosis, line of therapy, buy/bill versus specialty, age, race, sex, or insurance type (commercial vs federal).

Patients who received infusion therapy via buy & bill reported a mean approval time of 11.65 days until first infusion; patients who went through specialty pharmacy for infusion therapy reported a mean 17.56 days from approval to first infusion.

Patients who were treated through the chronic care management medical home at the practice had a nearly halved time to drug start time (8.6 days vs 14.85 days). This was among the key findings from Stewart and colleagues at the conclusion of the trial.

“Our overall approval times and drug start times are relatively fast, suggesting that having dedicated and trained prior authorization coordinators plays a role in getting patients on advanced therapy sooner, though increases overhead for our practice,” investigators wrote. “Participation in chronic care management home led to faster drug start time as we have dedicated clinicians involved in the process.”

The team additionally noted in their conclusion that patients in need of insurance appeal faced significantly longer approval times—though all were eventually approved—and such requirements are presenting a risk of delayed therapy to treat IBD.

“Prior authorization requirements continue to place significant administrative and financial burden on practices, lack transparency and ultimately delay patient care,” the team wrote.

References

Stewart A, Cohen ER, Attiogbe KM, Lang J, et al. Time Is of the Essence: An Analysis of IBD Advanced Therapy Initiation in a Large Community Practice. Abstract presented at: American College of Gastroenterology (ACG) 2024 Scientific Sessions. Philadelphia, PA. October 25 – 30, 2024.