“Prior authorization can help ensure that patients have access to safe, effective, affordable, high-quality care by helping to guard against potential overtreatment or inappropriate treatments that contribute to unnecessary costs and/or potential harm to patients,” an AHIP document says. “However, there is agreement that prior authorization can be burdensome to providers, consumers, and health plans alike. …Increasing the adoption of electronic prior authorization was one of the five major opportunities identified for improving the prior authorization process.”
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November 2023In the Fast PATH pilot program, AHIP says a “subset” of providers for six insurance plans began using Availity for medical services and Surescripts, a platform for electronic prior authorization, for prescriptions. A survey that elicited responses from 309 providers on at least one survey question described the benefits of the two platforms. According to the results, during the six months after providers began using the electronic platforms, 62% of all prior authorizations were done electronically. That was a drop of 48% in the number of prior authorizations that were performed manually, and providers reported a 34% increase in prior authorizations performed overall during that period.
Before incorporating electronic platforms into their procedures, 17% of prior authorization decisions were received in two hours or less, respondents reported, according to AHIP. That rose to 33% in the six months after starting the pilot program. Before the program, 61% of prior authorization decisions were received within 24 hours. After starting, that number rose to 71% over the first six months. In addition, before the program, 24% of prior authorization decisions took more than two days. During the six months after starting the program, only 15% of decisions took more than two days.
While the number of prior authorizations performed through electronic means is climbing, many are still done manually, according to AHIP. In a survey performed last year, insurance providers reported that 39% of prior authorizations on medications and 60% of prior authorizations for medical services were performed manually.
The insurance companies reported that 71% of the insurance plans surveyed said that the providers’ electronic health record (EHR) isn’t enabled to perform electronic prior authorizations and that it would be too costly or burdensome for the providers to buy a new EHR platform or update an existing one to allow pre-authorizations to be done.
AHIP did not make a representative available for this article to discuss the prior authorization process and related digital tools or to respond to physicians’ concerns that the burden of prior authorization is growing, although the group did offer statements: