641 A Quality Improvement Initiative to Reduce Insurance-Related Delays in Patient Access to Biologic Therapies for Inflammatory Bowel Disease

Abstract

INTRODUCTION: Most quality improvement (QI) initiatives in inflammatory bowel disease (IBD) address clinical processes such as screening and vaccinations. Applying the principles and methods of QI, we conducted an initiative that encompassed insurance-related workflow processes required for prompt patient access to biologic IBD therapies. METHODS: The QI cohort comprised 22 gastroenterologists who were attending staff in an academic medical center (N = 14) or center-affiliated community clinics (N = 8). At baseline, the gastroenterologists completed a survey designed to assess their self-reported knowledge and practices involving insurance-related processes. We retrospectively audited the charts for 200 of the gastroenterologists' patients with confirmed active ulcerative colitis or Crohn's disease who had been prescribed a biologic medication. Assessments included the number of days between prescription request and various milestones involving prior authorization (PA) and prescriptions being filled and dispensed. In the intervention phase, the gastroenterologists and their clinical teams participated in a series of accredited grand rounds activities. Participants received audit feedback and developed action plans to reduce identified delays in patient access to biologic medications. Six months after the interventions, we audited the charts of 100 additional patients, assessing the same temporal measures as in the baseline review. RESULTS: The baseline survey findings indicated that 41% (21% academic vs 75% community) of gastroenterologists reported having limited or no confidence in understanding pre-authorization requirements; 18% (29% vs 0%) had standardized letters of necessity for patients needing biologics; and 9% (7% vs 13%) received approval for treatment coverage within 3-4 days. Patient characteristics were similar across the 2 sampling periods; median age was 37 (19-82) years, 54% were female, 62% had Crohn's disease, and 88% were covered by commercial insurance (Table 1). Across the baseline to follow-up audits, the mean number of days was reduced for key milestones, including prescription request to PA approval (11 vs 7 days), prescription written (18 vs 10 days), and prescription dispensed (43 vs 21 days; Figure 1). CONCLUSION: These findings reflect the potential for extending QI principles and methods to workflow processes in order to reduce insurance-related delays and facilitate prompt patient access to needed biologic therapies.