Next Generation Physician Exemption Solution Leverages Motive’s Practicing Wisely Appropriateness of Care Measures
October 09, 2023, San Francisco, California – Motive Practicing Wisely Solutions (Motive), a pioneer in provider performance benchmarking and measurement, has announced Evidence-Based Goldcarding for physicians, a solution that avoids unnecessary costs for patients, improves safety, and supports physicians in practicing appropriately.
Since the advent of managed care, the prior authorization process has been a source of friction between providers and health plans and widely blamed for delays in care. A recent industrywide survey revealed that 89% of physicians experienced a negative impact on clinical outcomes due to prior authorization processes.[1] To mitigate this, goldcarding, or approval process exemption, based on a physician’s historic approval rates was introduced to reduce administrative burden and delays.
However, these first-generation goldcarding programs have not performed as expected.[2] Some health plans have report that goldcarding programs show no improvements in quality while spending has increased. Physicians complain that goldcarding requirements, based solely on denial rates from legacy prior authorization systems, have little to do with a physician’s competence or adherence to evidence-based care pathways. Furthermore, they are opaque and arbitrary; for example, denial rates across Medicare Advantage plans in 2021 spanned from 3% to 12%.[3] From the perspective of payers, once physicians are goldcarded under these first-generation programs, their performance is no longer visible and cannot be assessed effectively.
Motive’s Evidence-Based Goldcarding solution builds on the core strength of goldcarding programs — improving care access, quality, and cost — while eliminating the deficiencies of the first-generation programs. Because Motive’s solution is rigorously evidence-based, it maps directly to the prior authorization protocols that payers currently use and deploy. Furthermore, because it is based on Motive’s market-leading appropriateness of care measures, it monitors a physician’s practice and updates payers every six months on the performance of physicians operating under goldcards. Key benefits of Motive’s Evidence-Based Goldcarding solution include:
- Exempting physicians based on decision-making aligned with clinical evidence
- Leveraging industry-leading performance measurement using Motive’s Practicing Wisely Appropriateness of Care Measures
- Ensuring objectivity through a rigorous, statistically derived range of acceptable variation to ensure that physicians have broad latitude to make optimal clinical decisions for individual patients
- Supporting transparency by providing physician access to the evidence and methodology behind the measures
Organizations using Motive’s Evidence-Based Goldcarding include:
- Health plans — to reward high-performing physicians and right-size prior authorization programs
- Risk-bearing health care organizations — to improve physician performance and standardize care in alignment with clinical evidence
- Prior authorization technology platforms — to add provider performance data to prior authorization process automation
“The evidence foundation and rigorous methodology of Motive’s goldcarding solution takes prior authorization where it was always intended to go—aligning payers, providers, and patients in the pursuit of the highest-quality, most cost-effective care,” commented Jeanne Cohen, CEO of Motive.
About Motive Practicing Wisely Solutions
Motive Practicing Wisely Solutions offers a proven toolset that recognizes positive physician performance, yielding higher-value care. Motive enables the benchmarking and measurement of individual physicians based on their use of evidence to make clinical decisions over time. The physician-centric Appropriateness of Care Measures, Quality of Care Measures, and Cost of Care Measures provide the foundation of Motive’s physician performance analytics platforms.
Press Contact:
Teresa O’Keefe
tokeefe@motivemi.com | 410.903.1393
[1] AHIP. AHIP 2022 Survey on Prior Authorization Practices and Gold Carding Experiences. AHIP website. https://ahiporg-production.s3.amazonaws.com/ documents/2022-Prior-Auth-Survey-Results-FINAL.pdf. Published November 14, 2022.
[2] Waddill K; TechTarget, Inc. Gold Carding Has Mixed Effects on Streamlining Prior Authorization Processes. Health Payer Intelligence website. https://healthpayerintelligence.com/news/gold-carding-has-mixed-effects-on-streamlining-prior-authorization-processes. Published November 30, 2022.
[3] Eisenberg R; Fortune Media IP Limited. Fortune website. https://fortune.com/well/2023/04/24/changes-coming-to-medicare-advantage-prior-authorization-rules/. Published April 24, 2023.