The Surescripts Blog

Live Video Chat Recap: Healthcare Leaders Discuss the “Abysmal” Prior Authorization Process and Opportunities to Fix It with Technology

By: Olivia Vandenbussche, Marketing Manager, Surescripts

Abysmal.

That’s the first word that comes to mind when Mandi Bishop talks about today’s prior authorization process.

During Surescripts’ early-December live video chat, Taking the Pain Out of Prior Authorization, Bishop, co-founder of Aloha Health and a passionate patient advocate, said the process has become a “tragic comedy.” She went on to explain, “But, unfortunately, people are dying. Patients die as a result of prior authorization decisions not being made in a timely manner.”

During the chat, industry experts talked about the increasingly complex and challenging prior authorization landscape. They shared their perspectives on the current pitfalls and opportunities to change the process by giving healthcare professionals access to real-time data and flexibility for exemptions and exceptions.

“Everything doesn’t fit into a perfect box,” said Dr. W. Ryan Neuhofel, (who goes by “Dr. Neu”). “There are always exceptions to the rule.”

Dr. Neu, a practicing direct primary care physician and owner of NeuCare Family Medicine in Lawrence, Kansas recently shared a video of a typical experience with a phoned-in prior authorization request for a CT scan. The call lasted 21 minutes. And the video went viral. Dr. Neu called the process full of “hoops,” saying “I don’t even understand it. So how can a patient understand it?”

The chat participants talked about how to improve the process by transitioning away from manual to electronic, like Surescripts CompletEPA®. With electronic prior authorization integrated directly with physicians’ existing electronic health record (EHR), they have a direct connection to their patients’ pharmacy benefit managers (PBMs).

“When using CompletEPA, physicians get a response in 3-4 seconds from the PBM,” said Luke Forster-Broten, product manager for Surescripts. “This enables providers to set expectations with the patient.” And because 60 percent of approvals come back in under 60 seconds, the process can be completed before the patient even leaves the office—a factor that Bishop and Dr. Neu agree has the power to make or break the patient-doctor relationship.

The discussion only reinforced the major deficiencies of today’s manual prior authorization process. It also shined a light on technology’s incredible potential for workflow improvement—and for saving lives—now and in the future.

Watch the video chat:


And read Survey: Providers, EHR Vendors Weigh In on the Importance of Electronic Prior Authorization to see what healthcare professionals and EHR vendors think about the electronic prior authorization process.

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