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Major advocacy groups band together to streamline prior authorization

The medical associations identified five opportunities to make immediate reform.

Beth Jones Sanborn, Managing Editor

A new effort is officially underway to improve the prior authorization processes for patients' medical treatments. Groups including the American Hospital Association, America's Health Insurance Plans and American Medical Association, issued a Consensus Statement calling for short-term reform.

"This will help patients have access to safe, timely, and affordable care, while reducing administrative burdens for health care professionals, hospitals and health insurance providers," the AHA said. Other organizations signing the statement include: American Pharmacists Association, Blue Cross Blue Shield Association and the Medical Group Management Association.

[Also: Prior authorization needs streamlining, new healthcare coalition including AMA, MGMA says]

If a treatment or prescription requires prior authorization, in fact, it must be approved by a health insurance provider beforehand. The process can be burdensome for healthcare professionals, hospitals, insurers, and patients since individual processes can vary according to the payer or provider and also can be repetitive.

According to their Consensus Statement, however, the organizations outlined five areas where immediate reform is possible. These first steps will include: decrease the ranks 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 the health insurance provider; evaluate services and medications that require prior authorization and eliminate unnecessary prior auth requirements where possible;
enhance communications between health insurance providers, healthcare professionals, and patients to minimize care delays and ensure clarity on prior auth requirements, reasoning, and changes; protect continuity of care for patients when there are changes in coverage, health insurance providers or prior authorization requirements; and hasten industry adoption of national electronic standards for prior authorization and improve transparency of formulary information and coverage restrictions at the point-of-care.

"By forging an agreement addressing an important set of prior authorization challenges, this collaborative is leading the industry toward the dual aim of reducing the volume of required authorizations and decreasing complexity in conducting these transactions," MGMA Senior Vice President of Government Affairs Anders Gilberg said.

Twitter: @BethJSanborn
Email the writer: beth.sanborn@himssmedia.com

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