Last month, I briefly touched on our focus to reduce administrative burden for our participating providers, as well as our recent decision and commitment to eliminate close to 65% of prior authorization requirements for medical services for PCPs by early 2025. This month I wanted to delve a little further into that decision.

From a bigger perspective, this is a key part of our commitment to support our provider network and streamline access to care for patients and members. This move is consistent with past decisions, including our groundbreaking removal of all prior authorizations for outpatient behavioral healthcare in 2018. 

Prior authorization helps ensure that your patients receive the most appropriate, safe, and cost-effective care, and can also promote new care standards and reduce redundant care. Despite those benefits, it has been identified nationally as a cause of unnecessary delays in getting care, being inefficient, and causing frustration for providers as well as patients.

As part of our overall efforts to support primary care in Rhode Island, BCBSRI realized we needed to do something to address this situation. So, we engaged in discussions with state regulators, members of the General Assembly, and stakeholders throughout the local healthcare system, who are critical to ensuring its effectiveness. We then took a data-driven approach to identify the most common orders that create more work for PCPs. That review will lead to lifting prior authorization requirements for many medical services, such as radiology and cardiology, and we will continue to look at other ways to streamline prior authorization going forward. These changes will benefit providers and patients in commercial and Medicare plans.

Our work in this area aligns with the work undertaken by the Rhode Island Office of the Health Insurance Commissioner (OHIC). OHIC released a primary care report in December 2023 titled Primary Care in Rhode Island that found that clinician burnout is a “key concern” for the local healthcare workforce, and that the significant administrative burden of prior authorization requirements can contribute to it. In our March column, I detailed several other ways that BCBSRI is working to address and improve the primary care landscape in our state.

We want to hear your concerns – talk to us!

Eliminating prior authorizations is just a start as we work to eliminate some of your administrative burden for our primary care network and make it easier to work with BCBSRI. We want to hear from you about how else we can make things easier and smoother for you. That’s why we’re holding a “listening tour” starting soon, which will be clinically led meetings with PCP physicians at their offices to hear their concerns and pain points first-hand. If you are a primary care physician in Rhode Island and you’d like us to visit your practice or office, please email me.

As always, thank you for all you do to keep our members and all Rhode Islanders safe and healthy.