Prior authorizations are considered obstacles by many physicians and patients alike, with 9 in 10 physicians saying in an American Medical Association survey prior authorization has a negative effect on patient outcomes.
To combat that burden, UnitedHealthcare is rolling out a gold-card program that will reward contracted provider groups that "consistently adhere to evidence-based care guidelines" by allowing certain physicians to bypass the prior authorization process.
While some physicians and groups have expressed concern over the program, other physicians are optimistic it could help combat lengthy wait times and existing prior authorization requirements.
Joshua Rosenow, MD. Director of functional neurosurgery at Northwestern Medicine (Chicago): UHC has been the perpetrator of some of the most onerous prior authorization requirements. While the gold-card program does not solve all of the myriad issues with UHC prior authorization, it will hopefully reward practices for successfully navigating UHC's thicket of prior authorization requirements with a year of exemptions. However, this is renewable annually and it is unclear exactly how UHC will recertify practices' gold-card status if they are not submitting prior authorization requests. It is possible that submitting annual data and medical records to maintain gold-card status could be just as time consuming and frustrating as the prior authorization process itself. Moreover, the list of procedures that would be eligible for inclusion in the gold-card program won't be released until Sept. 1, so we don't yet know how applicable this will be to spine and pain practices.
Zeeshan Tayeb, MD. Owner and medical director of Pain Specialists of Cincinnati: The proposal behind the gold-card program from UHC is one that will work to help alleviate pre-certification requirements if the program works as designed. The qualifying criteria for provider enrollment is something that will help raise the standards of care for all patients receiving treatment. It would be an additional incentive if providers qualifying for the UHC gold card enrollment were provided an elevated fee schedule for services.