A quick guide to understanding patient access and how it’s reshaping the US healthcare industry
Among current healthcare and life science trends, “patient access” is an important concept, certainly one that industry professionals are likely to hear about often. The term itself, though, means different things to different people. Here we will examine the various definitions of “patient access,” the ways in which it shapes the US healthcare system, health care providers, and other health services - and why life science information, regulatory and competitive intelligence professionals should be aware of this important topic.
At its most basic, “patient access” is defined quite literally. It refers to the availability of healthcare, the ability of consumers to access care and treatment.
Patient access is an integral part of the Affordable Care Act (ACA). The four-year rollout of the program includes a number of provisions for access to “affordable health insurance options” and “increasing access to affordable care.” A detailed summary of the law mentions patient access 14 times, including access to “quality, affordable care,” “innovative medical therapies,” “an effective appeals process” for insurance appeals, “physician care and other services,” “community-based, coordinated care,” and “clinical preventive services.”
Beyond this now-legally-mandated baseline, however, the concept of patient access has additional meanings and raises additional questions for both providers and consumers. As a concept, patient access influences many facets of healthcare and affects all major stakeholders.
5 Key Definitions of Patient Access
The term “patient access” is used in many different contexts, to mean different things. Below is a Q&A to explain five of the most common uses:
- What is a patient access department?
In many healthcare facilities, such as hospitals, the patient access department manages registration, insurance verification, billing, admissions, etc. The National Association of Healthcare Access Management (NAHAM) explains that patient access professionals handle registration and support for “patients, providers and payors into, through and out of their health care experience.”
- What is a patient access portal?
Many healthcare facilities offer patient portals, which are secure websites offering 24-hour access to personal health information. Patients who register for an account may access health information such as lab results, medications, discharge summaries, billing information, and scheduling information (HealthIT.gov).
- What is patient access to physicians?
Although closely linked to the broader concept of access to care, physician availability is a separate and critically important issue. Patients who obtain insurance and become eligible to receive care may do so only if qualified physicians and healthcare facilities are available and accessible. A recent benchmarking report from Merritt Hawkins found that physician access varies considerably by state. The report examined 33 variables to identify states in which patients are most and least likely to obtain access to a physician. (An infographic summarizes the findings by state.)
- What are organized efforts to enable patient access to therapies and care?
Apart from the high-level push for universal access to healthcare, specialized advocacy groups work to ensure patient access to specific therapies and clinical care. The Alliance for Patient Access (AfPA), for example, is a national network of physicians that sponsors physician working groups, health policy initiatives, and conferences; distributes educational materials; and organizes meetings with health policymakers. The AfPA’s Issues page outlines key topics of interest, including specific therapeutic areas, policy concerns and other initiatives.
- What is patient access to experimental drugs?
Many advocacy efforts focus on patient access to experimental or unapproved treatments. For critically ill patients who may not survive long enough to wait for FDA approval of new drugs, experimental or not-yet-approved medications may offer the only possible treatment. Patient demand and advocacy efforts have led a number of states to adopt “right-to-try” laws that allow terminally ill patients to receive experimental drugs or devices. The FDA has also expanded its guidelines for compassionate use, investigational drugs and off-label uses of approved drugs. (Duane Morris provides a useful overview of the topic.)
In all of its iterations, “patient access” is about closing the gap between the patient and the many pieces of the healthcare puzzle. Insurance, facilities, physicians, health records, clinical care and treatments—all of these are critical elements of wellness, and all are important issues for life science information, regulatory and competitive intelligence professionals to consider when evaluating and analyzing healthcare news and trends.
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