Healthcare orgs collaborate to streamline prior authorization

Six healthcare organizations are joining forces with the goal of streamlining preapproval for patients’ medical treatments. The collaboration, they said in a press release, will give patients access to timely, affordable care while reducing administrative burdens for healthcare professionals, hospitals and insurance providers.

The American Hospital Association, America’s Health Insurance Plans, American Medical Association, American Pharmacists Association (APhA), Blue Cross Blue Shield Association and Medical Group Management Association released a consensus statement Jan. 17 outlining their shared goals for prior authorization.

The document highlighted five areas for improvement:

  1. Selective application of prior authorization. The organizations agreed to implement requirements based on evidence-based medical practices, provider performance and participation in a value-based agreement with an insurance provider.
  2. Program review and volume adjustment. They pledged to regularly review the services and prescription drugs that are subject to the prior authorization requirements and eliminate requirements for therapies that no longer need them.
  3. Transparency and communication. By improving communication between insurance providers, healthcare professionals and patients, the organizations hope to clearly articulate preapproval requirements, rationale and changes.
  4. Continuity of patient care. The organizations hope to establish systems that minimize repetitive prior authorization requirements and encourage protections for patients to maintain their treatment regimen when there are changes in coverage.
  5. Automation to improve transparency and efficiency. The organizations will work to accelerate industry adoption of national systems to facilitate the electronic exchange of documents, reducing administrative burdens associated with preapproval and reducing the time to treatment initiation.

“We are very supportive of this collaborative effort that is critical to improving patients’ access to needed medical services and medications, promoting continuity of care, and removing provider burdens,” said Thomas E. Menighan, executive vice president and CEO of the APhA. “Adoption of these principles will free physicians, pharmacists, and others to spend more time in patient care.”