Accelerating access: The power of gold carding in reducing treatment delays.

Abstract

114 Background: Delays in time to treatment initiation (TTI) for cancer patients have been shown to impact survival/mortality/outcomes, and cause patient distress. The process of obtaining prior authorizations (PA) often leads to significant treatment delays, affecting patient outcomes and posing administrative challenges for healthcare providers. PAs have become a ubiquitous part of modern healthcare, aimed at ensuring appropriate utilization of medical treatments and reducing costs. In recent years, the concept of gold carding (GC), a practice where payers waive PA on services and prescription drugs ordered by providers with a proven track record of PA approvals based on guideline concordance or pathway adherence, has gained attention as a potential solution to provide administrative relief to all stakeholders affected by the PA process. This abstract seeks to explore the impact of GC on TTI for a large multi-site community-based oncology practice in The US Oncology Network having a GC contract with a regional payer. Methods: Using administrative claims data from 2021 to 2023, we derived a population of cancer patients who initiated chemotherapy as their first treatment, calculated the TTI (time from the date of first consultation to the date of treatment initiation), and compared TTI between GC and non-GC patients. Results: The average TTI for 4,836 patients that met the inclusion criteria was 26.3 days. Patients initiating therapy under a GC eligible payer coverage started therapy 4.5 days earlier (22.13 days vs 26.68 days, p<0.00001, Kruskal–Wallis test). 80% of GC eligible patients started their treatment within 30 days of their initial consultation. Conclusions: The findings indicate that gold carding has the potential to expedite the time to treatment initiation for cancer patients. Further research is needed to quantify the cost savings, patient and provider satisfaction, and other intangible benefits from GC. Gold carding offers a viable approach to balance guideline concordant care with lowering administrative burden. We enthusiastically support legislative reforms that encourage gold carding and selectively implement prior authorization requirements based on stratification of health care providers’ performance and adherence to evidence-based medicine. Patient Count Average TTI (days) GC 401 22.13 Commercial 217 21.13 Managed Medicare 184 23.32 Non-GC 4435 26.68 Commercial 1610 25.41 Managed Medicare 1405 27.37 Medicare 959 26.48 Managed Medicaid 254 29.06 Medicaid 112 29.54 All Other 95 30.15