MGMA Week in Review: Prior Authorization Cuts, Workplace Happiness, EHR Updates, and Mental Health System Reforms

According to Healthcare Dive, senior reporter Rebecca Pfeiffer reported on March 19th, that OptumRx is eliminating prior authorization Reauthorizations for about 80 drugs used to treat chronic conditions like migraines, multiple sclerosis, and high cholesterol. So starting May 1st, this move will cut up to 25 percent of all reauthorizations, about 10 percent of prior authorizations overall.

Prior authorizations have long been a pain point for physicians, pharmacists, and patients, adding layers of paperwork and often delaying necessary care. OptumRx's move follows industry pressure to streamline the process and reduce administrative burden. While PBMs argue these requirements control costs, critics say they hinder patient care and lead to harmful delays.

This change comes amid growing scrutiny of PBMs like OptumRx, which along with CVS Caremark and Express Scripts have faced antitrust concerns and legislative efforts aimed at curbing their power, with regulators circling and competitors touting Transparent models. OptumRx's latest reform could be as much about public relations as patient care.

For now, at least, some patients and providers will breathe a sigh of relief, not to be confused with the sigh of frustration that usually accompanies dealing with prior authorizations. Okay, Daniel, over to you.

And that's a big deal because when employees are happy, they're more engaged, more productive, and more likely to stick around. Plus, happy employees lead to better patient experience and stronger financial performance. So really, everyone wins. And that brings us to an interesting case study. Out of the Harvard Business School, Lanco Medical Group. This is a fast growing pharmaceutical intermediary in Central and Latin America that's doing something a little different.

They're making workplace happiness a key part of their strategy for growth. The co founder, Lissette Hermida, realized that in order to expand successfully, they had to keep their employees motivated and engaged, especially because they're working across multiple countries and dealing with both government in private sector clients. So what's really cool is how they decided to measure happiness.

They brought in a third party company to survey employees not just about work, but about their overall life satisfaction. And the results? Well, they were eye opening. Some of the perks Lanco thought were big wins, like free healthcare and company trips, weren't actually appreciated as much as they expected. In fact, employees saw them as just part of the job, not as incentives. They had to be, that had to be tough to hear as a leadership team, but instead of getting defensive, Lanco leaned in.

They listened, and they adjusted their approach. One of their biggest insights? Employees wanted better financial education. At first, the leadership team questioned whether that was even their responsibility, but then they realized if financial stress is affecting job performance, it makes sense to address it. So they started offering financial literacy programs to help employees plan for their futures. And that's really the takeaway here.

Workplace happiness isn't just about throwing perks at employees. It's about understanding what truly matters to them. And that's going to change over time. What motivates someone fresh out of school is different from what a seasoned professional wants. Leaders who take time to ask, listen, and adapt are the ones who build strong, engaged teams. For medical practice leaders, this is something worth thinking about.

And if you are offering benefits and incentives that truly resonate with your team, well, That's the question you have to ask. And if you're not, maybe it's time to start asking. So Colleen, what's next?

Some practices are taking a phased approach, having switched in 2024 and planning further enhance Enhancements this year among those sticking with their current system. Many recently transitioned and are satisfied with their platform, while others are staying put due to cost considerations or physician preference. Few respondents cited contractual obligations as a reason for not switching, suggesting more flexibility in the EHR. EHR marketplace.

And then I AI powered documentation tools and new integrations are emerging as popular add ons for groups looking to enhance not replace their current systems. And why does all this matter? Well, selecting the right EHR system, as many of our listeners know, is a high decision, and one that can make or break operational efficiency, revenue cycle management, and clinician satisfaction.

To support leaders considering a transition, MGMA has updated its guidance on crafting a strong RFP, or Request for Proposal, that reflects the following.

The latest regulatory requirements, including interoperability mandates under the 21st Century Cures Act, evolving technology offerings such as cloud based systems, AI powered documentation, and data analytic tools, and the specific needs of different types of practices, from smaller outpatient clinics Needing simple turnkey solutions to large multi site systems, requiring robust data exchange, compliance, and advanced reporting capabilities.

A well structured RFP ensures EHR vendors don't just promise the moon, but demonstrate how their system meets the real. clinical, financial, and operational needs of your organization. And on that note, Daniel, I mentioned at the beginning of the podcast, I got to attend an event for the first time. Well, that was the HIMSS Colorado chapter advocacy day breakfast this past Monday. You know, super interesting, lots of panelists who were just really dynamic.

Well, our stat poll reminded me of a panel session there that highlighted some of the unique technology hurdles that providers in alternative care settings, like behavioral health. senior living and community health centers face. And lo and behold, one of the big things that came up was the ongoing challenges with EHR systems and these alternative care environments and how many of the established EHR platforms just aren't well suited for the needs of their settings.

So Jason Greer, one of the panelists, he's the CEO of Community Health Provider Alliance. and Colorado Community Managed Care Network. He noted how the EHR technology in primary care is often behind the curve compared to the rest of the industry. And Stephanie Haley Andrews from Atria Senior Living mentioned how they've had to really work to move their senior living data away from subjective free text notes toward more structured objective assessments.

The panelists emphasized the importance of EHR systems that can support whole person coordinated care across the community, so integrating physical, mental, and social needs. But they said the data, the data sharing and interoperability to enable that level of coordination is still a major challenge, even with newer cloud based EHR options.

So, it's clear that EHR selection and optimization remains a top priority for many practices, whether they're looking to make a full vendor switch or just significantly update, upgrade their current system. The need for technology that can truly meet the unique needs of different care settings is an ongoing pain point that providers are working to address. And hey, MGMA members, if your organization is thinking about an EHR change, Make sure your RFP doesn't just check the boxes.

It should align with your practice's long term strategy and avoid turning into an expensive regret. So as always, we'll drop the link to our MGMA stat poll results article in the show notes. Check that out for more information and how to develop a really, uh, really tailored RFP for your new EHR. system. And hey, do you want to have your voice heard in future MGMA polls? Well, just join MGMA stat by texting STAT STAT to 33550 or visit mgma. com slash MGMA.

hyphen stat to participate in weekly healthcare leadership insights sent via text. It's real easy. Okay, Daniel, back to you.

These fish are born in cold, rocky river beds, swim downstream to the ocean, spend a few years living their best lives, and then, well, you probably know the rest of the story. They fight their way back upstream, dodging bears, leaping over waterfalls, and pushing through some serious currents. Just a return to where they started and they do all this without GPS, a wellness app, or an overpriced cup of coffee. Now if that's not dedication, I don't know what is.

So what can doctors take away from the life cycle of a salmon? A few big lessons, actually, and I might add, this article originally appeared in Physician's Practice. It's an opinion piece there, and so, let's get into it. First, remember your roots. Just like salmon instinctively return to their birthplace, physicians should remember the mentors, the training, and the early experiences that shaped their careers. Medicine is a tough road, but those who came before you paved the way.

Keeping those connections strong can keep you grounded. Next, perseverance. If you think med school was tough, try swimming against a raging current for hundreds of miles while predators wait to snatch you up. Salmon don't quit, and neither do doctors. You push through long hours, administrative headaches, and ever changing policies because you believe in the work you do. That persistence is what makes great doctors, just like it makes great salmon.

If salmon had medical degrees, then there's leaving your comfort zone. Salmon don't just stick to their safe little rivers. They explore vast open waters. Adapting to new environments. Doctors, the same deal. Whether it's adapting, adopting new technologies, learning a new specialty. or adjusting to the latest health care regulations, success comes from adapting and growing. And then, let's not forget deferring gratification.

Salmon give up eating during their long journey upstream, all in service of the bigger goal. Sound familiar? Whether it's residency, long shifts, or putting patient care before personal comfort, physicians understand what it means to delay rewards for a greater purpose. And then finally, adaptability. Male salmon actually change physically as they prepare for the final stretch of their journey, growing hooked jaws and sharper teeth to protect their future. Doctors may not grow.

New teeth, thankfully, but they do have to evolve constantly, whether it's shifting their approach to patient care or adjusting to new health care models. The bottom line, nature has some pretty solid wisdom to offer. Physicians like Salmon, navigate complex and demanding journeys.

And while there's no one size fits all roadmap, staying connected to your purpose, pushing through challenges, and adapting along the way are the keys to a meaningful career, and, hopefully, a successful swim upstream. Colleen, keep on swimming. What is

A recent MedCity News article by Jenna Glover published on March 18th covers the state of mental health care and why simply scaling teletherapy and existing models isn't enough to fix the system. Here's some key takeaways from the article. The current mental health system is struggling with health high costs. Long wait times and staffing shortages making care inaccessible for many. Expanding a broken system isn't the solution.

Instead of just increasing teletherapy or traditional care options, healthcare leaders need to rethink how mental health services are structured and delivered. AI and digital tools are playing a growing role offering real time support for individuals who may not have access to traditional therapy, but they need to be integrated responsibility, responsibly ensuring evidence based ethical care. Health equity remains a major challenge.

Many marginalized communities are still being left behind and solutions need to be Culturally responsive, scalable, and accessible. For healthcare leaders, this is a wake up call. Simply adding more therapists or expanding telehealth options won't solve the deeper issues in the system.

Instead, the industry needs to focus on innovative, holistic approaches that blend human expertise, AI driven tools, and new care models to meet patients where they are, especially those who have been historically underserved. At the end of the day, mental health care doesn't need a bigger truck, it needs a better road. And for those leading the charge in health IT operations and patient care, the challenge is to build that road with smarter, more effective, and more equitable solutions.

And again, we will drop that link in the show notes, so you can check it out for more information. And that does it for me today, Daniel.