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  • Major Health Industry Groups Look to Streamline Prior Authorization

    While prior insurance authorization may be right up there with death and taxes when it comes to life's certainties, 6 major health industry groups believe the process could be much improved.

    The American Hospital Association, America's Health Insurance Plans, the American Medical Association, the American Pharmacists Association, BlueCross/BlueShield, and the Medical Group Management Association issued a consensus statement outlining 5 ways the health care system could "improve the [prior authorization] process, promote quality and affordable health care, and reduce unnecessary burdens." Those 5 areas are:

    Selective application of prior authorization. The consensus letter argues for basing application of prior authorization on "provider performance on quality measures and adherence to evidence-based medicine or other contractual agreements."

    Regular reviews of prior authorization and adjustments for volume. "Regular review of the list of medical services and prescription drugs that are subject to prior authorization requirements can help identify therapies that no longer warrant prior authorization due to, for example, low variation in utilization or low prior authorization denial rates," according to the statement.

    Better communication and transparency. The group calls for improved communication between health plans, providers, and patients "to minimize care delays and clearly articulate prior authorization requirements, criteria, rationale, and program changes."

    Attention to continuity of care. The statement identifies continuity of care as "vitally important" and urges "additional efforts to minimize the burdens and patient care disruptions associated with prior authorization."

    More automation. "Moving toward industry-wide adoption of electronic prior authorization transactions based on existing national standards has the potential to streamline and improve the process for all stakeholders," the group states in the letter.

    "This consensus statement is a step in the right direction," said Elise Latawiec, PT, MPH, APTA staff lead for practice management. "The areas noted in the statement align very closely with APTA's positions on relieving administrative burdens and its efforts to explore potential solutions, and we are looking at ways to support and collaborate on this important effort."

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