Magazine article Medical Economics

Experts: Prior Authorizations Are Here to Stay, but Could Get Easier

Magazine article Medical Economics

Experts: Prior Authorizations Are Here to Stay, but Could Get Easier

Article excerpt

* While some

longstanding traditions will be left in the dust with the rise of value-based care, one that won't is the use of prior authorizations to control costs.

"We literally just asked a gathering of payers and providers if the use of evidence-based criteria, utilization management, and prior authorization are going to fade in the next three years or so, as a result of the move to value-based care and [accountable care organizations] and so on," said Laura Coughlin, vice president of clinical development with McKesson Health Solutions. "Tey were fairly unanimous in saying absolutely not. Tat's because the desire to ensure that people are getting safe, efective, quality care is not going to go away."

Craig Samitt, MD, global head of the healthcare provider practice at Oliver Wyman, agreed. He said prior authorization, clinical profling, limited networks, and other administrative techniques remain an essential method for insurers and providers to deliver value, but their use is no longer just one-dimensional "mother may I approvals."

"Tey have evolved to the point where insurers selectively use these tools to guide consumers to higher-quality clinicians, evidence-based and clinically appropriate services, and lower cost but equally efcacious care options," he said.

Coughlin said technology also is driving the revival of pre-authorizations-both in its ability to speed up authorizations and its role in creating more information for physicians to learn.

"Authorizations that used to take one, two, three, even 15 days to get a decision can now move forward immediately. …

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