While prior authorization has a longstanding reputation for delaying care and causing administrative confusion, the vast majority of health plans use the process to improve care quality and safety, promote evidence-based care, and encourage physicians to reduce unnecessary tests, treatments and procedures. In fact, most health plans see investing in the streamlining of this process for both prescription medications and medical services as a top priority and “the biggest opportunity for improvement.”
It’s a good reminder that sometimes the most notoriously painful processes in healthcare were originally designed to help providers fulfil their commitment to ultimately doing what’s right for the patient.
That said, it’s time to give providers a vastly more efficient and automated path to a decision, while preserving the essence of what makes prior authorization valuable and necessary in the first place.
To gain a better grasp of electronic prior authorization’s real-world impact on patients and providers, America’s Health Insurance Plans (AHIP) launched an initiative in early 2020: Fast Prior Authorization Technology Highway, or Fast PATH.
AHIP Report on Fast PATH Initiative.
RTI analyzed over 40,000 prior authorization transactions from participating health plans within the study period to assess measures of prior authorization volume, approval rates, and processing time for prior authorization requests
Over a 12-month period, RTI International independently analyzed more than 40,000 prior authorization transactions before and after implementation, and asked more than 300 providers to share their experiences. AHIP selected Surescripts and Availity to demonstrate the impact of a fully digitized prior authorization process.
The report shows that electronic prior authorization enhances care quality by enabling a faster decision, removing delays to patients receiving care, and reducing the burden on providers while giving them better information.
Key findings conclude that after implementation of electronic prior authorization:
- The median wait time for a decision was more than three times faster—a 69% reduction from 18.7 hours to 5.7 hours.
- While payers did not see a statistically significant increase in approval rates, they were able to approve prior authorizations more quickly and speed patient access to therapy, with 71% of providers who use these tools for most or all patients (experienced users) reporting improved timeliness.
- More than 60% of experienced users spent less time on phone calls and faxes.
- 60% of experienced users said it was easier to understand if prior authorization was required, and more than half said it was easier to understand prior authorization requirements and to view the prior authorization decision.
“The more frequently a provider used the technology solution, the bigger the benefit the provider experienced in reduced burden and ease of understanding prior authorization information.”
In stark contrast with the manual, paper-based version, the report’s key findings on the impact of electronic prior authorization are impressive and conclusive. The technology doesn’t just replace an outdated and inferior workflow. It fulfills prior authorization’s original promise better, faster and more reliably than fax and phone ever could have. And it helps health plans effectively clear the way for providers to deliver care quality, safety and efficiency—all while demonstrating to members that their health and satisfaction are what matter most.