A recent analysis, spearheaded by America’s Health Insurance Plans (AHIP), has revealed that electronic prior authorization (ePA) can significantly reduce the time between a request for prior authorization and a decision, as well as the time to a patient receiving care.
AHIP launched its Fast Prior Authorization Technology Highway—or Fast PATH— initiative to better understand how electronic prior authorization could impact the process for patients and providers. Six health insurance providers—Blue Shield of California, Cambia Health Solutions, Cigna, Florida Blue, Humana, and WellCare (now Centene)—that collectively cover over 50 million Americans participated in the project, with Availity and Surescripts serving as the technology partners.
The ePA approach allows physicians and their staffs to request approval from pharmacy benefit managers (PBMs) and health plans inside their electronic health records (EHRs). Across the industry, most EHRs, health systems, payers and pharmacies have committed to electronic prior authorization.
The AHIP initiative began in early 2020 and ran for approximately 12 months. RTI International conducted an independent evaluation of the project, with Point of Care Partners serving as an expert advisor to the project. The evaluation included analyzing prior authorization transaction data before and after implementation of ePA, and surveying providers on their experiences using ePA technology, according to officials who released a press release on the findings this week.
The study found that 71 percent of experienced providers who implemented ePA reported faster time to patient care. In addition, ePA reduced the time between submitting a prior authorization request and receiving a decision from the health plan by 69 percent; the median time from prior authorization request to decision fell from 18.7 hours to 5.7 hours.
“Prior authorization is an important tool in helping patients receive safe, effective, clinically appropriate care,” said Kate Berry, senior vice president of clinical affairs at AHIP. “We are always looking for ways to enhance the patient and provider experience, and electronic prior authorization is an example. Today’s analysis provides a blueprint for how to leverage electronic tools to improve prior authorization.”
Other key takeaways from the Fast PATH study include:
Less burden for providers from prior authorization-related phone calls and faxes after implementation of ePA for experienced users
- 54 percent of experienced users reported fewer phone calls while 62 percent of experienced users reported less time spent on phone calls
- 58 percent of experienced users reported fewer faxes while 63 percent reported less time spent on faxes
Improved transparency of prior authorization requirements for providers who implemented ePA
- 60 percent of experienced users said electronic prior authorization made it easier to understand if prior authorization was required.
- 57 percent of experienced users said electronic prior authorization made it easier to understand the requirements for prior authorization.
- 54 percent of experienced users said electronic prior authorization made it easier to view the prior authorization decision.
Greatest benefit for providers who use technology for most or all their patients
- The more frequently a provider used the technology solution, the bigger the benefit the provider experienced in reduced burden and ease of understanding prior authorization information
“The review of over 40,000 transactions showed the impact electronic prior authorization makes in health care,” said Denise H. Clayton, Ph.D., research economist, health economics and evaluation at RTI International. “Because clinicians and their staff report more benefits from ePA when they use it more often, greater provider adoption of ePA could help further realize its promise.”
Berry added, “ePA has shown that it can reduce burden on providers and streamline care for patients,” Berry said. “Health insurance providers are committed to using proven technologies like ePA to improve patient care and provider experience.”
