DOTmed October 4, 2024
The American healthcare system is a complex network wherein every decision has downstream impacts. Among these, the prior authorization process often stands out as a source of physician frustration, leading to delays in necessary treatments and increased patient anxiety. This issue is compounded by the slow adoption of automation solutions and advanced utilization management (UM) strategies. Many providers and health plans still rely on outdated methods and fee-for-service models, leading to a reactive approach to UM that lacks real-time data and proactive care management.
This outdated approach contributes to the prevalence of low-value care—medical services that do not align with evidence-based guidelines and offer minimal clinical benefit. These services not only fail to provide meaningful value but also often expose...
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