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Physicians Say Utilization Management Has Gotten Out of Hand

By Hannah Cloe

Mon May 08 2017

Doctors frustrated with payer-imposed administrative burdens seek to restore clinical autonomy.

American Society of Clinical Oncology

With healthcare reform once again top of mind for organizations and stakeholders across the country, the American Society of Clinical Oncology (ASCO) released a statement on changes they would like to see implemented in payer-imposed utilization management strategies. Prior authorization, clinical pathways, step-therapy protocols, restrictive formularies and specialty tiers were all taken to task with detailed commentary on their use, misuse, and consequences within oncology.

ASCO’s message was clear throughout the five-page document that reads like a managed care manifesto: payer-imposed administrative rules prioritize cost-saving above all else and place unnecessary burden on physicians and practices, jeopardizing patient outcomes in the process.

Earlier this month, inVibe asked a panel of oncologists, rheumatologists, and gastroenterologists how they would react to a payer mandating that they start patients on a biosimilar instead of a reference biologic.

Despite a general sense that biosimilar agents will be largely undifferentiated, this question elicited an intense and confrontational tone from respondents.

“I don’t like being told what to do and I don’t like medical decision making being made by a payer.”

“My response to that, to mandate a change… would be very significant, and quite aggressive, trying to fight that decision.”

“In general, I do find it frustrating when a payer tries to dictate my treatment plan because I try to treat the patient, not just the disease.”

The story comes to life even more through xVibe, inVibe’s speech emotion recognition (SER) analytics. Arousal, a measure of the speaker’s energy or excitement, jumped to 62.9% for this single question about payer mandates compared to an average of just 48.4% for the rest of the study. In other words, responding to this hypothetical scenario evoked an intensity of emotion that was simply not there when physicians were responding to other questions about the market — underscoring just how seriously they take the degradation of clinical autonomy in recent years.

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