Aetna expanding program that bundles medical imaging prior authorizations with other cancer care
Aetna is expanding a program that bundles prior authorizations for medical imaging with other cancer care as it seeks to reduce friction for physicians.
The insurer, which is part of the larger CVS Health, began using this new approach across all cancer types, effective Sept. 1. Aetna said the bundling applies to all individuals with managed-Medicaid plans in eligible states.
Leaders hope to eventually expand prior authorization bundling across all lines of business in 2027, the insurer said Thursday. This builds on success seen in the initial roll-out, with nearly 25% of eligible members receiving a bundled prior authorization.
The program combines requests across medical oncology to include chemo and immunotherapy, radiation oncology services and associated high-tech imaging needs such as MRI or CT. This allows providers and their patients to submit a single request for a care episode, rather than several separate ones for each component.
“A cancer diagnosis can be overwhelming for patients and families, and the care team should be focused on their patient, not paperwork,” Katerina Guerraz, Aetna chief operating officer and president of Medicaid, said in a statement Sept. 17. “By approving a broader set of treatments and related services upfront, we're removing barriers that can delay care.”
On average, Aetna said it was seeing providers submit four separate prior authorization requests for each member in need of cancer treatment. Administrative burden remains a “significant challenge” for physicians, the company noted. According to the latest Aetna Provider Survey, about 74% of clinicians identified administrative burden as the top challenge facing healthcare staffers today. Nearly one-third (or 31%) cited prior authorization management as the single largest contributor.
“By reducing this burden, Aetna can help clinicians unlock more time for patient care,” the payer noted, adding that about 30% of survey responded believed they could save over an hour daily on admin tasks through solutions such as bundling.
Aetna said it hopes to expand eligibility to Medicare and commercial members sometime in the first half of 2027.
Marty Stempniak has covered healthcare since 2012, with his byline appearing in the American Hospital Association's member magazine, Modern Healthcare and McKnight's. Prior to that, he wrote about village government and local business for his hometown newspaper in Oak Park, Illinois. He won a Peter Lisagor and Gold EXCEL awards in 2017 for his coverage of the opioid epidemic.