News & Media

MSMS Board of Directors Meet, Discuss Prior Authorization, Team-based Care

Thursday, January 30, 2020

During the January meeting of the Michigan State Medical Society (MSMS) Board of Directors, the Board discussed the latest information in regards to Health Can't Wait, a coalition of patients, physicians, and health care providers dedicated to putting Michigan patients first and ending delays in patients' access to health care, and an initiative to team-based care.

HEALTH CAN’T WAIT

Michigan patients would be one step closer to the timely care and treatment they need with action from members of the state Senate Health Policy and Human Services Committee, who, on Thursday, heard testimony from physicians, patients, and patient advocates on legislation that reforms prior authorization and step therapy practices—policies insurance companies use to slow—and sometimes deny—life saving health care. 

Patients, physicians and advocates including S. Bobby Mukkamala, MD, president-elect of the Michigan State Medical Society testified in support of Senate Bill 612, the Health Can’t Wait Act. The bill is sponsored by state Sen. Curt VanderWall, who serves as chairman of the Senate Health Policy and Human Services committee.

The Health Can’t Wait Act would introduce new transparency, clinical validity and fairness requirements to prior authorization and step therapy practices, empowering physicians to override step therapy protocols when they consider it not to be in a patient’s best interest. The act would also require insurers to base their prior authorization requirements on clinical, evidence-based criteria established with input from practicing physicians.

The Health Can’t Wait Act would also establish:

  • Transparency – Insurance company prior authorization requirements will be published on the insurer’s website in detail and in easily understandable language.
  • Clinical validity – Adverse determinations and decisions on appeals must be made by a physician in the same specialty as the service being requested. Medical directors of insurance companies must be licensed to practice medicine
  • Fairness for patients – Urgent and non-urgent prior authorization requests must be acted upon by insurers within 24 and 48 hours, respectively.

Please visit http://HealthCantWait.org to write your lawmakers to support Senate Bill 612 and learn more.

TEAM-BASED CARE

MSMS embarked on a project to explore the intersection of scope of practice laws as they relate to team-based care. Although originally intended to focus on role clarity within physician-led health care teams, but the focus quickly shifted to the potential for high-functioning, physician-led teams to impact physician wellness and achieve the Quadruple Aim of improved patient care, lower costs, better outcomes, and clinician satisfaction. Supporting this shift in thinking was the recognition that value-based reimbursement, population health measurement, increased administrative hassles and duties, workforce shortages, and patients with increasingly complex needs are driving the need for effective team-based care.

The committee, which consisted of members from MSMS’s Committee on Health Care Quality, Efficiency, and Economics chaired by John E. Billi, MD, (Washtenaw), developed a plan to help physicians foster high-functioning teams by utilizing MSMS’s communication channels, relationships with other stakeholders, and ability to create resources for members. Examples of activities include identifying high-functioning teams, communicating best practices and lessons learned, creating a resource library, and pursuing opportunities to participate in pilot projects such as the American Medical Association’s and Physician Foundation’s Practice Transformation Initiative.

The next step is to begin the creation of a task force that will develop a timeline for rollout and implementation strategy. If you are interested in being a part of the team-based care initiative, please contact Stacey Hettiger.