Leadership

Health Groups Pledge to Improve “Burdensome” Prior Authorization Process

The approval process required for some medical procedures can cause headaches for everyone involved. Groups representing every part of that process, from facility to insurer, have pledged to work together to improve it.

One of the key points of friction between health insurers and medical providers might just get smoothed over a little bit.

The process of “prior authorization,” in which a physician is required to receive approval from a patient’s insurer before he or she has a costly medical procedure, is often a big headache for doctors and medical facilities—and the insurers themselves.

A new collaboration among six major organizations that serve the medical space is setting out to provide some relief. This week, the groups—which include the American Medical Association (AMA), America’s Health Insurance Plans, the American Hospital Association (AHA), the American Pharmacists Association, the Blue Cross Blue Shield Association, and the Medical Group Management Association—announced that they would focus on five areas where the prior authorization process can be improved.

“The prior authorization process can be burdensome for all involved—healthcare providers, health plans, and patients. Yet, there is wide variation in medical practice and adherence to evidence-based treatment,” the coalition said in a consensus statement published on the AMA website. “Communication and collaboration can improve stakeholder understanding of the functions and challenges associated with prior authorization and lead to opportunities to improve the process, promote quality and affordable healthcare, and reduce unnecessary burdens.”

The five issues include the selective way that prior authorization is applied; the regular review of what services are subject to prior authorization; the need for communication and transparency; the continuity of patient care; and the use of automation to improve efficiency and transparency.

In a news release, AHA Executive Vice President Tom Nickels said that while the organizations come from different vantage points, the consensus statement reflects “goals we share with our partners in the health field.”

“These principles provide a good starting point for providers and health plans to work together toward continuous improvement in quality of care and health outcomes while reducing unnecessary administrative burden,” Nickels said.

The release adds that as the groups continue to collaborate on prior authorization issues, “these processes will be further refined to maximize efficiency and minimize care disruption for patients.”

(alexskopje/iStock/Getty Images Plus)

Ernie Smith

By Ernie Smith

Ernie Smith is the social media journalist for Associations Now, a former newspaper guy, and a man who is dangerous when armed with a good pun. MORE

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