Michael Drescher: Pioneering Change in Payer Strategy at Xsolis
In the ever-evolving landscape of healthcare, the role of payers has become increasingly complex, particularly in the realm of prior authorization. Michael Drescher, the Vice President of Payer Strategy at Xsolis, stands at the forefront of this transformation. With over 20 years of experience in healthcare and communications, Drescher is dedicated to navigating the intricate challenges that payers face while advocating for innovative solutions that enhance efficiency and collaboration.
The Tipping Point for Prior Authorization
On January 17, 2023, the Biden administration announced the CMS Interoperability and Prior Authorization Final Rule, marking a significant shift in how prior authorization processes are managed. This new mandate aims to streamline the authorization process for Medicare Advantage patients, providers, and health plans, addressing the critical need for improvement in this area. The rule requires payers to provide clear reasons for denied prior authorization requests and mandates timely responses—within 72 hours for expedited requests and seven calendar days for standard requests.
Drescher recognizes that speed is just one of many inefficiencies plaguing prior authorization. As healthcare systems grapple with strained resources, the new legislation imposes additional demands on teams already managing heavy workloads. The consensus among payers and providers is clear: simplifying and streamlining prior authorization processes is essential for improving patient care and operational efficiency.
Embracing Technology for Transformation
As the healthcare industry seeks to modernize its approach to prior authorization, Drescher emphasizes the importance of leveraging technology. Emerging tools, particularly in artificial intelligence (AI), are being utilized to enhance decision-making and operational efficiency. A recent McKinsey report identified utilization management, including prior and concurrent authorization, as one of the most significant opportunities for AI impact in the payer sector.
Drescher advocates for a collaborative approach, where payers and providers work together to solve shared challenges. By sharing real-time clinical data, both parties can enhance care management and value-based programs. This collaborative spirit is not just about improving prior authorization; it extends to concurrent authorization processes, discharge planning, and overall care coordination.
The Role of Concurrent Authorization
While prior authorization encompasses a wide range of procedures, concurrent authorization focuses on determining a patient’s status—whether inpatient or under observation—during their hospital stay. This process requires close collaboration between payers and clinical teams, as decisions must be made based on rapidly changing clinical information.
Drescher highlights that many legacy systems lack the integrated support provided by modern technologies. The Final Rule legislation encourages greater collaboration in prior authorization, which can also benefit concurrent authorization processes. By implementing API technology by 2027, payers will be able to automate prior authorizations and facilitate seamless information exchange among patients, providers, and stakeholders.
Innovative hospitals are already using technology to prioritize case reviews and share clinical data with health plans. This real-time access allows health plans to apply AI to determine which cases require deeper review, significantly speeding up the status determination process.
Building Trust Through Collaboration
At the heart of Drescher’s vision is the belief that trust, communication, and collaboration are essential for a successful healthcare ecosystem. He advocates for a culture where health systems and health plans work together transparently, utilizing data and analytical tools to support clinical decision-making. By fostering an environment of trust, both parties can streamline processes, reduce friction, and ultimately enhance patient care.
The modernization of prior authorization processes is just the beginning. The principles of collaboration and transparency can also be applied to concurrent authorization, creating opportunities for improved workflows and faster status determinations. As the healthcare industry embraces AI and other next-generation technologies, the potential for meaningful digital transformation is immense.
Conclusion
Michael Drescher’s leadership at Xsolis exemplifies the proactive approach needed to address the challenges facing payers in today’s healthcare landscape. By championing the integration of technology and fostering collaboration between payers and providers, Drescher is paving the way for a more efficient and patient-centered healthcare system. As the industry continues to evolve, his insights and strategies will undoubtedly play a crucial role in shaping the future of payer strategy and improving the overall healthcare experience for all stakeholders involved.