The American College of Gastroenterology's prior-authorization task force is the latest professional group to criticize UnitedHealthcare's new gold-card program.
Beginning Oct. 1, 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. A number of GI procedures, including intestine imaging and GI endoscopic ultrasounds, will be eligible for the new program.
While some physicians have expressed optimism over the new program, professional groups including ACG and the American Gastroenterological Association have slammed UHC's program, calling it a new form of prior authorization.
"Gold card programs were initially hailed as a pathway to improving quality of care while reducing administrative burden typical of utilization management requirements. However, as implemented, these programs are poised to be nothing more than the next generation of arduous, failed prior authorization protocols – especially because eligibility is assessed by past prior authorization approval rates, not by demonstrating better health outcomes," the ACG wrote in a Sept. 9 statement sent to Becker's.
"ACG remains skeptical about the benefits of gold card programs because they rely on the same faulty logic as their predecessors: that insurers, not physicians, should be the arbiter of what is best for a patient," the statement continued. "When establishing prior authorization protocols, insurers selectively use clinical guidelines to determine a course of treatment, instead of their proper use as a starting point. But physicians know better: patients cannot be treated as a monolith, and final clinical decisions must always rest with providers and patients."
UHC disagreed and pointed to how PA works to ensure care is fully up to date and evidenced-based. "The UnitedHealthcare Gold Card program is the next step in our continual efforts to modernize the prior authorization process and simplify the healthcare experience for consumers and providers," a UHC spokesperson told Becker's. "Prior authorization isn’t required for most gastroenterology procedures. Gastroenterology provider groups who meet the criteria will be included in the program. We haven't announced any plans to introduce prior authorization for GI procedures in 2024."