Optimization Reviews are a tool used by Medicare, businesses, and private insurers to improve healthcare quality, safety, and affordability.

In the medical world, these reviews are often labeled ‘prior authorizations’ by hospital systems and providers.

Regardless of the term used, they serve as important safety and cost checks for patients.

For example, they can stop the over-prescribing of opioids, or flag that a patient is on a separate medication that has a dangerous interaction with opioids.

They can also prevent dangerous adverse drug events.

10 percent of optimization reviews in one study uncovered potential medication errors that could have harmed patients. Nearly 70 percent of the cases where optimization reviews stopped errors were classified as either major or catastrophic.

Optimization reviews also help drive affordability.

For instance, some doctors accept money or gifts from drug and medical device companies who want the doctors to prescribe their drugs and use their products. These reviews make sure patients receive the most affordable and beneficial treatments, regardless of the doctor’s financial incentives.

Optimization Reviews also prevent fraud, waste, and abuse, which represents 25 percent of total medical spending. They also can prevent unnecessary tests, duplicate imaging, and redundant lab work.

Getting rid of optimization reviews will increase premiums by $2,800 for a family of four.

While these reviews are important, they can be made more efficient through new technology and transparency.

People should get the care and medicine they need in a timely manner.

The Affordable Healthcare Coalition of North Carolina is committed to advocating for policies that will ensure safe, quality, and affordable access to care.