IDC Perspective: Prior Authorizations Deep Dive — Feasibility Now Foreseen to Solve This Health Ecosystem Menace
Description
IDC Perspective: Prior Authorizations Deep Dive — Feasibility Now Foreseen to Solve This Health Ecosystem Menace
This IDC Perspective outlines the context, pain, and initiatives undertaken by payers, governments, organizations, providers, and vendors to address the prior authorization annoyance in the health ecosystem."Although prior authorization has been historically troublesome for healthcare stakeholders across the board, there is a light at the end of the tunnel," says Jeff Rivkin, research director, Payer IT Strategies at IDC Health Insights. "Data-driven collective decision making is key to solving prior authorization. All major players in the health ecosystem have issued a 'Consensus Statement on improving the Prior Authorization Process,' value-based contracts are driving collaboration, dozens of vendors are attacking the problem, and technological solutions such as FHIR, RPA, AI, ML, and CDS are at the forefront of healthcare IT's contribution to fixing prior authorization. A collaborative approach is the only way to tackle the issue. We now have the means and motivations to address this controlling transaction that exemplifies the pain caused in the fragmented healthcare/payer environment."
Please Note: Extended description available upon request.
This IDC Perspective outlines the context, pain, and initiatives undertaken by payers, governments, organizations, providers, and vendors to address the prior authorization annoyance in the health ecosystem."Although prior authorization has been historically troublesome for healthcare stakeholders across the board, there is a light at the end of the tunnel," says Jeff Rivkin, research director, Payer IT Strategies at IDC Health Insights. "Data-driven collective decision making is key to solving prior authorization. All major players in the health ecosystem have issued a 'Consensus Statement on improving the Prior Authorization Process,' value-based contracts are driving collaboration, dozens of vendors are attacking the problem, and technological solutions such as FHIR, RPA, AI, ML, and CDS are at the forefront of healthcare IT's contribution to fixing prior authorization. A collaborative approach is the only way to tackle the issue. We now have the means and motivations to address this controlling transaction that exemplifies the pain caused in the fragmented healthcare/payer environment."
Please Note: Extended description available upon request.
Table of Contents
19 Pages
- Executive Snapshot
- Situation Overview
- Overview
- What Is (Advanced) Prior Authorization?
- Pain Points
- Payers' Pain Points
- Employer Pain Points
- Providers' Pain Points
- Members/Patients' Pain Points
- What Are Payers Doing to Address These Pain Points?
- Staffing Up
- Health Information Exchanges
- Electronic Submission
- Automation
- Operating with Transparency
- Not Treating PAs Only as a Back-Office Problem
- Unfortunately, Only Solving for the "Happy" Path
- Investing in Solutions That Work for a Certain Payer or Certain Specialty
- Audit-Based Systems: Gold Carding Physicians
- Sunset Programs
- Increased Information at the Point of Care
- What Should Payers Pay Attention to Now?
- Prior Authorization Under Value-Based Payment Contracts
- Government and Organizational Initiatives
- American Medical Association Prior Authorization Initiatives and Collaborations
- CMS Interoperability and Patient Access Final Rule (CMS-9115-F)
- CMS Documentation Requirement Lookup Service
- HL7 Da Vinci Project
- ONC P2 FHIR Task Force
- Federal Legislation
- State Legislation and Initiatives
- CAQH CORE's Operating Rules for Prior Authorization
- American College of Radiology's Appropriateness Criteria
- Vendors
- Advice for the Technology Buyer
- Learn More
- Related Research
- Synopsis
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