Association’s Board to Evaluate Prior Authorization Process

The Medical Association recently received information from a consortium of health care providers, which included the American Hospital Association, America’s Health Insurance Plans, the American Medical Association, the American Public Health Association, Blue Cross Blue Shield Association and the Medical Group Management Association, who have partnered to identify opportunities to improve the prior authorization process. The Board of Censors during its last meeting tasked the Council on Medical Services to further investigate the consortium’s report.

The consortium’s goals are to promote safe, timely and affordable access to evidence-based care for patients; enhance efficiency; and reduce administrative burdens. However, according to a 2012 Kaiser Family Foundation estimate, physicians spend 868.4 million hours annually on prior authorizations. In a 2011 study by Health Affairs, the average annual per-doctor cost of interacting with insurance plans to complete prior authorizations was about $83,000.

The consortium has targeted five areas that offer improvement in prior authorization programs that can bring meaningful reform:

• Selective application of prior authorizations
• Prior authorization program review and volume adjustment
• Transparency and communication regarding prior authorization
• Continuity of patient care
• Automation to improve transparency and efficiency

Once the Council on Medical Services concludes its investigation, more information will be available.

Read the Consensus Statement on Improving the Prior Authorization Process from the consortium.

Read the Medical Association’s feature article from Alabama Medicine Magazine, Between Doctors & Patients: Prior Authorizations