Addressing gaps between payer policies and AASM clinical practice guidelines using scorecards

Neeraj Kaplish, Lynn D'Andrea, R. Robert Auger, Peter Gay, Ofer Jacobowitz, Karin Johnson, Colleen Lance, Amy Licis, Susheel Patil, Michael Summers, Kunwar Praveen Vohra, Fariha Abbasi-Feinberg

Research output: Contribution to journalArticle

Abstract

The Payer Policy Review Committee of the American Academy of Sleep Medicine launched an initiative to assess the alignment between clinical practice guidelines and private payer medical policies. This article summarizes the importance of the initiative, details the scorecard development process, including an analysis of policy scores and subsequent revisions, and discusses the impact of the scorecards particularly as related to the scorecards on the clinical practice guideline for diagnosis of obstructive sleep apnea in adults. This initiative has increased communication and engagement amongmembers of the Payer Policy Review Committee and private payers, creating opportunities to advocate on behalf of sleep medicine providers and patients with sleep disorders, encouraging payers to modify existing policies so that evidence-based care is provided to patients with sleep disorders.

Original languageEnglish (US)
Pages (from-to)811-815
Number of pages5
JournalJournal of Clinical Sleep Medicine
Volume16
Issue number5
DOIs
StatePublished - May 15 2020

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Neurology
  • Clinical Neurology

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    Kaplish, N., D'Andrea, L., Auger, R. R., Gay, P., Jacobowitz, O., Johnson, K., Lance, C., Licis, A., Patil, S., Summers, M., Vohra, K. P., & Abbasi-Feinberg, F. (2020). Addressing gaps between payer policies and AASM clinical practice guidelines using scorecards. Journal of Clinical Sleep Medicine, 16(5), 811-815. https://doi.org/10.5664/jcsm.8410