Hospitals, payers and docs collaborate on prior authorization
Multiple healthcare stakeholders, including the American Medical Association, American Hospital Association and America's Health Insurance Plans, are coming together to streamline prior authorization processes.
Prior authorization can assure appropriate, cost-effective care, but it can also create a burden for hospitals, payers and patients, the group acknowledges.
A consensus statement highlights the groups’ “shared commitment to industry-wide improvements to prior authorization processes and patient-centered care,” and calls for selective application and regular review of therapies that may not require such approval.
Also included in the group are the American Pharmacists Association (APhA), Blue Cross Blue Shield Association (BCBSA) and Medical Group Management Association (MGMA), all calling for improving transparency and communication to improve prior authorization processes.
Tom Nickels, executive vice president of the AHA, said hospitals and health systems “are committed to delivering the best care for patients in the most efficient manner,” which are “goals we share with our partners in the health field.” “These principles provide a good starting point for providers and health plans to work together toward continuous improvement in quality of care and health outcomes while reducing unnecessary administrative burden,” said Nickels.
The consensus statement includes healthcare leaders working together to:
- Reduce the number of healthcare professionals needed for prior authorization requirements
- Regularly review services and medications that require prior authorization and remove ones that are no longer needed
- Improve channels of communications between the stakeholders “to minimize care delays and ensure clarity” on prior authorizations
- Protect continuity of care for patients
- Accelerate industry adoption of national electronic stands for prior authorization
Richard Bankowitz, M.D., chief medical officer of AHIP, said the collaboration will improve the “process, promote quality and affordable health care, and reduce unnecessary burden.”
AMA Chair-elect Jack Resneck Jr., M.D., called the consensus “a good initial step.”
Prior authorizations have become the norm in healthcare, particularly for pricey procedures and tests. They have helped keep down costs, but at the expense of more work for providers. A December 2016 AMA survey found that physicians were completing an average of 37 prior authorizations each week, which took about 16.4 hours to process.
Through this initiative, healthcare stakeholders hope to improve patient care and remove administrative burdens for providers, payers and pharmacists, while maintaining checks in the system to keep costs under control.