The UNC Hospitals Department of Pharmacy won an award for reducing patients' financial risk through drug pre-certification.
The hospital won the 2019 Innovator Award at the National Oncology Conference, hosted by the Association of Community Cancer Centers and held from Oct. 30 to Nov. 1.
Insurance companies have complex policies regarding what services and medications they will and will not cover, Suzanne Francart, assistant director of pharmacy for the Medication Assistance Program and Pharmacy Revenue Integrity team, said. If the hospital administers a drug or service but an insurance company refuses to cover it, the hospital and its patients face a significant financial burden.
“What we have done at UNC, and what we submitted and won the ACCC Innovator of the Year Award for, is building a pharmacy department-run, closed loop model to ensure that pre-certification is done prior to receiving high-dollar outpatient drugs,” Francart said.
Francart said they began implementing the model about six years ago, when high-dollar claims were increasingly denied by insurance companies. Many patients, including those receiving expensive chemotherapy, questioned why their services were not covered.
The pharmacy department now controls the entire drug administration process, Lindsey Amerine, assistant director of pharmacy at UNC Medical Center, said. The department proactively submits claims to insurance companies, helps patients enroll in free drug programs, mixes medications and makes sure medications are paid for correctly.
“Other institutions, especially academic institutions, have pieces of this,” Francart said, “but having pharmacy-owned front-end pre-certification, back-end denials management, and continuous quality improvement within a comprehensive model is the first in the nation that we’re aware of.”
Amerine expects other intuitions to take after UNC’s model, especially with the award highlighting its success.
“ACCC is a multidisciplinary organization, so it shows us that there are a lot of other institutions that see this as the best practice,” Amerine said.
Sarah Garfinkle, a fourth-year pharmacy student at UNC, said this award is a testament to the hospital’s commitment to providing high-quality patient care.
“It shows we’re doing everything we can to provide accessibility to our patients,” Garfinkle said. “And it’s kind of given me motivation when I’m looking into my residency programs and my jobs for next year, to kind of bring similar accessibility to anywhere to make sure that our patients are being cared for as efficiently as possible.”
Francart said the award will not only encourage other institutions to adopt this model — it also celebrates the efforts of those who worked to create this system.
“I think for us, as professionals, whenever you have the opportunity to publish, to submit for awards, to speak on the things that you do and the practices you’ve built, it’s sort of our due diligence not only to put it out here for other institutions to learn from or to potentially adopt, but it’s also a recognition of the teams who have been working to build those things,” Francart said.
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