eHealth Initiative Foundation Releases Considerations for Improving Prior Authorization in Healthcare
Result of Year-Long Effort Responding to Consumer & Healthcare Professionals’ Dissatisfaction
WASHINGTON – February 26, 2019 – Today eHealth Initiative (eHI) Foundation released “Considerations for Improving Prior Authorization in Healthcare,” the result of a year-long collaborative effort responding to the widespread challenges and dissatisfaction consumers and healthcare professionals have with prior authorization. Click here to download a copy of the Considerations to Improve Prior Authorization and here to register for the webinar.
“Prior authorization is one of the key reasons people get frustrated with their healthcare. The processes and policies are not always transparent. eHI put all the players in the same room— payers, providers, patients, vendors, and other healthcare stakeholders, to determine ways to streamline the process,” said Jennifer Covich Bordenick, Chief Executive Officer, eHealth Initiative & Foundation. “After numerous discussions and debates about what was important, we developed a set of recommendations to improve prior authorization practices.”
“As prior authorization continues to be one of the most burdensome administrative processes facing physician practices, we are pleased to see key industry stakeholders come together to develop this set of considerations,” stated Robert Tennant, Director of Health Information Technology Policy for the Medical Group Management Association. “We hope this effort, in concert with other industry initiatives, serves to decrease the overall volume of authorization requirements and automate the remainder.”
“The healthcare vendor community should embrace these recommendations for their patient, provider, and payer offerings. If we can increase transparency with simple, real-time access around clinical guidelines, procedures, and medical policy, we will greatly increase patient and provider satisfaction,” said Jon Zimmerman, athenahealth.
“Delays or denial of necessary care due to prior authorization are frustrating and have been shown to negatively impact patient care. We have seen great success with organizations that are able to build evidenced based point of care clinical guidance into EHRs,” said William Thorwarth, CEO, American College of Radiology. “Providers welcome the efficiency and transparency that comes with these efforts.”
“WEDI applauds eHIs work to improve policies and procedures of the PA process which nicely flow with that of WEDI’s PA Council’s recent report on the mechanics of the data exchange and electronic PA process. We are excited to continue to work with eHI and others who are focused on moving to a more electronic prior authorization process saving money and wasted effort all around.”— Charles W. Stellar, CEO, WEDI
The initiative brought together leaders from multiple organizations. For a complete list visit, https://www.ehidc.org/priorauth. Stakeholders agreed upon a series of key points:
- Transparency of payer policy and evidence-based clinical guidelines available at the point of care may, in many cases, reduce the need for prior authorization and minimize care delays.
- Reducing the overall volume of services and drugs requiring prior authorization could decrease administrative burdens and costs for all stakeholders. As long as care continues to be consistent with evidence and the person’s insurance coverage, prior authorization may not be needed (or needed as frequently) for certain conditions, people, or situations.
- Payers, healthcare professionals and vendors should use existing, industry-endorsed standards whenever possible and explore incorporating new electronic standards that have the capability to improve the prior authorization process.
- Payers and healthcare professionals should explore alternative payment models that promote bundled authorization for procedures, medications, and durable medical equipment that are associated with a particular episode of care.
The Considerations for Improving Prior Authorization in Healthcare document will be discussed today, in a webinar featuring:
- Jennifer Covich Bordenick, CEO, eHealth Initiative
- John Fleming, MD, Deputy Assistant Secretary for Health Technology Reform, ONC
- Anupam Goel, MD, Chief Health Information Officer, Clinical Services, UnitedHealthcare
- Sagran Moodley, SVP, Clinical Data Services, UnitedHealthcare; Chairman, HL7 Da Vinci Steering Committee; Co-Chair, DRLS Medicare Fee for Service Prior Authorization Pilot
- Foong-Khwan Siew, Director, eValue8, National Alliance of Healthcare Purchaser Coalitions
- Robert Tennant, Director, Health Information Technology Policy, MGMA
- William Thorwarth, MD, CEO, American College of Radiology
- Steven Waldren, MD, VP and Chief Medical Informatics Officer, American Academy of Family Physicians
- Jon Zimmerman, athenahealth
About eHealth Initiative
eHealth Initiative and Foundation (eHI) convenes executives from every stakeholder group in healthcare to discuss, identify, and share best practices that transform the delivery of healthcare, through technology and innovation. eHI, and its coalition of members, focus on education, research, and advocacy to promote the use of sharing data to improve healthcare. Our vision is to harmonize new technology and care models in a way that improves population health, consumer experiences and lowers costs. eHI serves as a clearinghouse and has become the go-to resource for industry through its eHealth Resource Center. For more information, visit www.ehidc.org/priorauth. To join the conversation on Prior Authorization, follow eHI’s Prior Authorization showcase page and connect with us on LinkedIn, Facebook, and Twitter.