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By Tiffany Avery, MD
Arthritis is a leading cause of work disability among US adults. An estimated 25.7 million adults are limited in their usual activities because of its affliction, and that number is expected to grow to 35 million by 2040.
An all-too-common accompanying autoimmune disease alongside other chronic conditions—including obesity, diabetes, and heart disease—arthritis is not often recognized as a serious issue. However, it has the menacing distinction of being the second-largest driver of employee health costs, in addition to claiming responsibility for 172 million lost workdays, and $304 billion in medical costs and lost earnings each year.
For businesses and worksites, this can drain productivity, increase medical expenses, and cause an uptick in absences.
Causes and Managing Arthritis
Experts don’t know the causes of many forms of arthritis and there are more than 100 types of the disease. Specific symptoms vary depending on the type but usually include joint pain and stiffness. There is no recorded cure for arthritis, but it can be treated and managed.
When arthritis symptoms, such as acute joint inflammation, are diagnosed early, effective treatment helps reduce symptoms and remission is a possibility. The significance of proper diagnosis, particularly in the early stages of the disease, may prevent serious, lifelong arthritic complications for patients.
In the case of rheumatoid arthritis (RA), early detection and intervention are key. RA stands a greater chance of evolving into a chronic inflammatory condition if left unchecked. Early diagnosis can prevent future discomfort, disability, and even deformity in severe cases.
Expediting Treatment and Access to Medication are Key
While new treatments are promising, it’s often overwhelmingly complex for providers to choose the best course of action for each patient’s unique case, condition, and specific type of arthritis. It can also be a bureaucratic marathon for payers to review prescribed treatments, approve, and authorize payment.
Innovative, evidence-based medicine is emerging as a solution: streamlining processes, seamlessly connecting payers and providers, and ultimately helping those suffering from arthritis in an efficient and convenient manner.
Tech platforms are now available and are helping payers and providers expedite arthritis treatment. Treatment validation tech can speed up prescription approvals which can also dramatically impact the rate of progression arthritis sufferers experience.
Providers often find themselves caught in the routine of starting down the rabbit hole of lengthy workflows to secure authorization for patient treatment. A molehill of paperwork can rapidly increase to a sizeable mountain. This is an ongoing and common industry obstacle, tracked by the CAQH Index, which reported that out of the $42 billion spent each year conducting administrative transactions, 48% of that amount—$20 billion–could be saved by transitioning to fully electronic transactions.
Tech solutions are designed to simplify the process for providers and their staff by simplifying information collection and distribution.
Improve data quality
Prior authorizations often require multiple interactions between providers and health plans, taking time and adding expense to the business of care. Requests for additional information and long appeals cycles are often involved. Providers also must worry about unexpected supplemental documentation, incorrectly associated and placed records, or delayed and rescheduled distribution. Advanced technologies bridge this gap and speed the process while simplifying workflow, pulling together disparate data providing a full picture of a patient’s needs, thereby helping reduce avoidable treatments and costs.
Alleviate the documentation guessing game
Industry-wide, a portion of prior authorization requests require supplemental documentation. Tech solutions can help solve the sometimes-unavoidable mystery of the additional information needs. With the ability to include documents with a specific prior authorization request, payers can see everything they need to make a decision all in one place.
Speed saves patients
An integrated solution doesn’t depend on time zones or rely on providers and payers answering their telephones or faxes; speed and efficiency, accomplished through technological advances, can help eliminate the burdens and stress associated with the myriad of processes required in our current health care system. Codified rules can be applied automatically, thereby adding value across the entire prior-authorization process to ease and expedite patient care.
Improving the communication between payers and providers through technology increases efficiencies, simplifies workflow, and pulls together disparate data to provide a full picture of a patient’s needs, thereby helping reduce avoidable treatments and costs across the health care spectrum, including the millions of people suffering from arthritis.
Dr. Tiffany Avery is Chief Medical Officer for NantHealth, responsible for providing clinical strategic direction. Dr. Avery joined NantHealth in 2019 as the Medical Director of Oncology and is a board-certified Medical Oncologist with a special interest in breast cancer and differences in cancer survival. Prior to her role at NantHealth, she served as an Assistant Professor of Oncology at Thomas Jefferson University and Wake Forest Baptist Health. After completing fellowship training at MD Anderson Cancer Center in Houston, Texas, Dr. Avery focused and lectured on clinical research and the care of breast cancer patients. Dr. Avery earned her BS and MPH in Epidemiology from Tulane University and MD from LSU Health Sciences Center New Orleans, Louisiana. She is also board certified in Lifestyle Medicine and co-host of 3 Black Docs, a podcast aimed at addressing health and cancer disparities.