posted by David Allen
on June 9, 2020
Just like doctors use scientific evidence to determine the safest, most effective treatments, health insurance providers rely on data and evidence to understand what treatments best improve patient health and target prior authorization programs to promote appropriate care. The vast majority of health insurance providers’ prior authorization programs incorporate physician input and design their prior authorization programs with the goals of improving quality and protecting patient safety. That’s according to a recent commercial survey of health insurance providers on prior authorization from AHIP.
The report found that health insurance providers use multiple sources of evidence-based studies, guidelines and federal standards in designing their prior authorization programs. More specifically, 98% of insurance providers use peer-reviewed evidence-based studies, and 89% use federal studies or guidelines. Below are some additional key takeaways:
The majority of health insurance providers are taking steps to streamline the prior authorization process for both prescription medications (91%) and medical services (89%) and a majority (84%) reported that automation of the prior authorization process is the biggest opportunity for improvement. To that end, AHIP recently launched the new Fast Prior Authorization Technology Highway (Fast PATH) – a demonstration project to evaluate the impact of automating the prior authorization process.
The survey was conducted between September and December of 2019, before the nation’s health care system faced significant changes and challenges brought about by the coronavirus (COVID-19). As elements of the U.S. health care system begin to re-open, AHIP members remain committed to working with providers to streamline the prior authorization process to ensure all patients receive safe, affordable care, evidence-based care at the right time and in the right setting.