Prior authorization was created to address fraud, waste and abuse in our healthcare system. It has become an onerous process that interferes with nearly every high-cost ordering action while only a fraction of orders are stopped. Payer- and policy-specific nuances make the process even worse. Patients end up waiting to receive medications and procedures, resulting in worse health. Prior authorization is a process that seems ripe for disruption.
The Simplifying Prior Authorization Executive Roundtable Series brings together relevant stakeholders to discuss industry-wide and stakeholder-specific strategies that might be used to help reform prior authorization. Over two meetings and a series of workgroup sessions, we will:
* Explore existing standards and common business processes to simplify prior authorization
* Outline challenges across clinical and technical domains
* Lay the groundwork for demonstration projects to test hypotheses suggested by the attendees
We will conclude the roundtable (after two larger meetings and interim workgroup meetings) with a joint statement outlining short- and long-term goals for the industry to help address existing challenges around prior authorization to better support providers, patients and payers.
* Can we consider processes to fast-track prior authorizations?
* Can we leverage a common evidence base or set of rules to address the “simplest” prior authorization requests and use electronic systems to better manage payer-specific exceptions?
* Do we need to develop new standards to share information and intent to expedite prior authorizations?
* How can use industry-wide solutions to minimize the friction among payers, providers and patients?
* How can we engage employers to help use the prior authorization process to directly affect the premiums they pay?
This meeting is by invitation only. If you are interested in participating in events like these, please contact Director of Programs and Services, Claudia Ellison - Claudia.Ellison@ehidc.org.