Can an industry effort to streamline prior authorizations work?

March 25, 2018

Prior authorizations have always been a source of frustration for physicians, but a new industry effort that includes medical groups and insurers has been established to try to streamline the process.

Prior authorizations have always been a source of frustration for physicians, but a new industry effort that includes medical groups and insurers has been established to try to streamline the process.

The American Hospital Association, American Medical Association (AMA), American Pharmacists Association, Blue Cross Blue Shield Association, Medical Group Management Association, and America’s Health Insurance Plans (AHIP) -the trade group for payers-issued a consensus statement in January outlining their commitment to improving the prior authorization process and patient-centered care.

“Working together, we can find the right solutions to improve the process, promote quality, and affordable healthcare and reduce unnecessary burden,” said Richard Bankowitz, MD, chief medical officer of AHIP in a statement.

There are five areas where the groups pledge to work together:

  • Reduce the number of healthcare professionals subject to prior authorization requirements based on their performance, adherence to evidence-based medical practices, or participation in a value-based agreement with a payer.

  • Regularly review the services and medications that require prior auths and eliminating requirements for therapies that no longer warrant them.

  • Improve channels of communications among payers, providers, and patients to minimize delays.

  • Protect continuity of care for patients who are on an ongoing, active, or stable treatment regimen when there are changes in coverage, providers, or prior auth requirements.

  • Accelerate industry adoption of national electronic standards for prior authorizations and improve transparency of formulary information and coverage restrictions at point of care.

“This collaboration among healthcare professionals and health plans represents a good initial step toward reducing prior authorization burdens for all industry stakeholders and ensuring patients have timely access to optimal care and treatment, Jack Resneck, Jr., MD, chair-elect of the AMA, said in a statement. 

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