Use of an advanced authorization review process.

Managing prior authorization in workers’ compensation is a key component to controlling costs, minimizing abuse, and managing absences. Cadence Rx Secure Managed Authorization Routing Technology (SMART) is advancing the process by combining a robust configurable scoring system, industry expertise and A/I.

The Cadence Rx SMART authorization process uses a combination of transaction driven variables, machine learning, prescribing patterns and clinical expertise to automate the routing/decision making process.

The use of an advanced authorization review process improves prior authorization response times and utilization review efforts, minimizing “rubber stamp” approvals by putting the decision in the right hands–resulting in reduced wait times and better outcomes for the patient.

Understanding the SMART Score

The scoring process starts with clinical expertise to define customizable, injury-specific formularies. However, managing appropriate off-formulary prescriptions has become more complex for a variety of reasons: the constant introduction of new drugs, complex multimedication regimes, escalating use of opioids, injury-specific drug lists, different jurisdictional formularies, high cost brand outliers and the volume of brand drugs moving to generics. Built from the ground up as an aid to this process, SMART uses a combination of variables, medical literature, population data and advanced analytics to develop a SMART Score between 1-100:

Informed Decisions = Better Outcomes

Each of these variables can be included or excluded and weighted by the client to calculate the SMART Score. Every prescription that requires prior authorization is scored using these factors and then fed into the SMART Decision Engine to determine the appropriate course of action. Using customizable threshold levels and category weighting, the client can predefine responses, routing rules or escalation procedures. In addition, the score can be presented on the prior authorization management tool (Sōlis) as a metric to assist in the decision-making process.

Discover how Cadence Rx is breaking the paradigm of how prescription benefits are managed.