New Analysis Shows Benefits of Electronic Prior Authorization for Patients and Providers (source: AHIP)

Key findings include faster time to patient care and easier administrative processes for providers

Electronic prior authorization (ePA) can significantly reduce the time between a request for prior authorization and a decision and the time to a patient receiving care.  These were two of the top findings from an initiative launched by America’s Health Insurance Plans (AHIP) to better understand the impact of ePA on the prior authorization process.

“Prior authorization is an important tool in helping patients receive safe, effective, clinically appropriate care,” said Kate Berry, Senior Vice President of Clinical Affairs at AHIP.  “We are always looking for ways to enhance the patient and provider experience, and electronic prior authorization is an example.  Today’s analysis provides a blueprint for how to leverage electronic tools to improve prior authorization.”

AHIP launched the Fast Prior Authorization Technology Highway—or Fast PATH—to better understand how electronic prior authorization could impact the process for patients and providers. Six health insurance providers—Blue Shield of California, Cambia Health Solutions, Cigna, Florida Blue, Humana, and WellCare (now Centene)—that collectively cover over 50 million Americans participated in the project, with Availity and Surescripts serving as the technology partners.

The initiative began in early 2020 and ran for approximately 12 months. RTI International conducted an independent evaluation of the project, with Point of Care Partners serving as an expert advisor to the project.  The evaluation included analyzing prior authorization transaction data before and after implementation of ePA, and surveying providers on their experiences using ePA technology.

The study found that 71% of experienced providers who implemented ePA reported faster time to patient care.  In addition, ePA reduced the time between submitting a prior authorization request and receiving a decision from the health plan by 69%.

Other key takeaways from the Fast PATH study include:

• Less burden for providers from prior authorization-related phone calls and faxes after implementation of ePA for experienced users
  • 54% of experienced users reported fewer phone calls while 62% of experienced users reported less time spent on phone calls
  • 58% of experienced users reported fewer faxes while 63% reported less time spent on faxes
• Improved transparency of prior authorization requirements for providers who implemented ePA
  • 60% of experienced users said electronic prior authorization made it easier to understand if prior authorization was required.
  • 57% of experienced users said electronic prior authorization made it easier to understand the requirements for prior authorization.
  • 54% of experienced users said electronic prior authorization made it easier to view the prior authorization decision.
• Greatest benefit for providers who use technology for most or all their patients
  • 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

“The review of over 40,000 transactions showed the impact electronic prior authorization makes in health care,” said Denise H. Clayton, PhD, Research Economist, Health Economics and Evaluation at RTI International.  “Because clinicians and their staff report more benefits from ePA when they use it more often, greater provider adoption of ePA could help further realize its promise.”

“ePA has shown that it can reduce burden on providers and streamline care for patients,” Berry said.  “Health insurance providers are committed to using proven technologies like ePA to improve patient care and provider experience.”

“The findings of this pilot are profound in terms of reduced time-to-therapy leading to improved patient care among other benefits,” said Tony Schueth, CEO & Managing Partner of Point-of-Care Partners, expert advisors to the project. “At the same time, they are consistent with other studies we have done in showing a wide variance in the proportion of prior authorization requests still not being submitted or responded to electronically. Therefore, there is still a significant upside to ePA that should lead to all stakeholders wanting to come together to make it work.”

“Medication only works if patients can access, afford and adhere to it,” said Mike Pritts, Chief Product Officer, Surescripts. “By working together across the industry to drive greater use of electronic prior authorization, we can eliminate phone calls and faxes, get patients started on treatment faster, and improve overall care by increasing medication adherence.”

For more information on prior authorization and the Fast Path initiative visit AHIP's website.

About AHIP

AHIP is the national association whose members provide coverage for health care and related services to hundreds of millions of Americans every day. Through these offerings, we improve and protect the health and financial security of consumers, families, businesses, communities and the nation. We are committed to market-based solutions and public-private partnerships that improve affordability, value, access, and well-being for consumers. Visit www.ahip.org for more information.