How the Prior Authorization Process Hurts Patient Outcomes

“Prior authorizations create significant barriers for family physicians to deliver timely and evidenced-based care to patients by delaying the start or continuation of necessary treatment … and can inadvertently lead to negative patient outcomes.”

— American Academy of Family Physicians (AAFP)

It’s no secret that the prior authorization process is frustrating for both doctors and patients alike, but new research shows just how much this inefficient process can hinder patient access to care and create healthcare issues that could easily be avoided.

According to the 2018 AMA Prior Authorization (PA) Physician Survey, an alarming 91% of patients experienced delayed access to necessary care due to the PA process. Even more unsettling, 28% of physicians say the PA process has led to a serious medical event such as hospitalization, disability, permanent bodily damage, a life-threatening event or death.

To make matters even more urgent, care delays associated with prior authorizations are a growing problem as PAs are on the rise. A recent survey of revenue cycle management and care management leaders by Porter Research found that 99% of organizations have seen a significant increase in the number of medical procedures that require prior authorization over the past two years.

PA Delays: Adherence and Abandonment Issues

PA delays are often associated with treatment adherence issues, an issue of epidemic proportion that’s entirely preventable. When it comes to medication alone, the Annals of Internal Medicine reports that the lack of adherence is responsible for around 125,000 deaths every year, and costs the health care system between $100 billion and $289 billion annually.

Studies show that 20 to 30% of medication prescriptions are never filled. While it’s unclear how many of these instances are directly tied to prior authorization delays, statistics show that PA delays often lead to abandoned treatment. Of the physicians surveyed by the AMA, 75% said that PA issues have caused their patients to abandon the recommended course of treatment.

Ninety-one percent of physicians identified the impact of prior authorization delays on clinical outcomes as significant or somewhat negative. Needless to say, the existing prior authorization system simply isn’t cutting it when it comes to patient care. Delays in care caused by PAs can and should be prevented.

Why Electronic Prior Authorization Isn’t Enough

While electronic prior authorizations (ePAs) are a step up from the arduous, paper-heavy process that the industry has dealt with for years, they’re still not quite efficient enough to prevent significant delays. While today’s system may involve fewer faxes and phone calls, ePAs still require ample man-hours to complete.

Consider that doctors and their staff spend an average of two business days every week on prior authorizations, with each physician processing around 31 PAs per week. The AMA survey reports that more than one in three physicians have staff that work exclusively on prior authorizations.

According to the Porter research, it takes an average of a week for the majority of organizations to obtain a prior authorization. Larger organizations are able to process PAs with more speed at the cost of more resources; the study found that 65% of hospitals with more than 500 beds have more than 15 FTEs dedicated to processing prior authorizations.

Processing ePAs can be time consuming as staff must often go to multiple portals, manually track down missing information and follow different workflows for various procedures or medications.

What if all parties involved could exchange data on a single, common platform to process prior authorizations without delay?

The Solution: How to Speed Up Prior Authorization

Truly automated PAs (aPAs) are the key to better patient care. When healthcare providers, payers, pharmacies and manufacturers can access and share data more efficiently, everyone benefits — most importantly, the patient.

Rather than working in silos and piecing together information via phone calls, faxes, various portals and endless piles of paper, PriorAuthNow makes it simple for all parties to collaborate on one independent open platform.

Better yet, this single common platform is a source for prior authorizations on everything, from medication and lab authorization to a complete range of medical procedures. PriorAuthNow is the first company to provide this depth of scope on a single, consolidated platform.

Providers no longer have to access multiple individual payer portals to submit prior authorizations as PriorAuthNow handles the submission process. This truly automated solution saves providers significant time and resources beyond what ePAs can achieve.

The Benefits: Improved Care and Patient Outcomes

Automating prior authorizations reduces the cost, time and man-hours required to process PAs. Along with requiring fewer resources, aPAs can improve patient satisfaction, which can directly impact adherence, HCAHPS scores and more.

Simplifying prior authorization through smart automated workflows and seamless data sharing significantly reduces the cost associated with managing PAs. Fewer man-hours dedicated to the process frees up ample resources to dedicate to other high priority areas.

Streamlining communications between physicians, payers and pharmacies reduces prior authorization turnaround times to increase productivity and efficiency for all involved. APAs give all parties the ability to track the status of pending authorization requests as they move through the approval process. Access to PA performance data also allows for more transparent negotiations.

Moving to automated prior authorizations has extensive benefits for all involved, most importantly, patients. Faster, more effective interactions with doctors, payers and pharmacies is only the beginning. Fewer delays can prevent avoidable health issues and dramatically improve patient care.