The Future of Prior Authorization In The Medical Fields

Saqib Ayaz
Aug 22, 2017 · 5 min read

Prior Authorization (PA) was known as a traditional, manual and well-intended process that involved faxes and phone calls between health care providers, prescribers, and pharmacies. The traditional method leads to many issues in the prescription process and there were errors in the manual method.

One study estimated that on average, prior authorization requests consumed about 20 hours a week per medical practice: one hour of the doctor’s time, nearly six hours of clerical time, plus 13 hours of nurses’ time. Other studies have suggested that prior authorizations could cost individual practices tens of thousands of dollars a year. (Source: The New York Times)

However, the recently developed software will help to reduce the errors and provide a better platform to accomplish the tasks related to prescriptions.

With the utilization of the latest Prior Authorization software following changes can be brought in the healthcare system.

• The staffs and prescribers will not have to spend any time on the Prior Authorization

• There is no need to abandon a high percentage of Prior Authorization because of the complex procedures and policies.

• It will help to manage the increasing volume of Prior Authorization

Automation of Prior Authorization and Challenges

We all know that there are many issues and challenges that healthcare providers had to meet because of manual authorization. However, with the automation of Prior Authorization, the participants in the industry will be able to provide the real-time information for the support of e-prescriptions and decision-making process.

It will help to dramatically reduce the administration cost and will create a beneficial platform for all the workers of the healthcare system.

Some of the benefits it will bring are:

• The workload will be reduced

• Patients will get the medical attention they require

• The efficiency and productivity of the system will be improved

As the industry of biosimilar drugs and medical specialties are increasing the importance of Prior Authorization will dramatically enhance. Some of the drugs will be targeted for a niche patient group and they will have higher rates that would be only management with authorization.

Most of the buyers will take the help from the Prior Authorization systems to make sure that the prescribed medications are only used to treat the targeted patients. Soon the complexity regarding the payers will also increase due to the developments in Pharma and medical fields.

Adoption of Prior Authorization

There are chances that soon for the adoption of electronic Prior Authorization the vendors will provide open platforms to grab the attention of healthcare providers.

Here are some of the factors that will help the healthcare providers to adopt this new technology.

1- Plan compatibility

The best solution will be provided by the Prior Authorization when it would help to submit the plans and process them consistently. The workflow will properly handle the prescriptions. It will conduct the job for everyone.

2- Prospective PA

PA will help them to complete the prospective reports before the claim of rejection is submitted in the pharmacy. It will help to avoid patient disruption and save the time. soon the PA will become the part of the e-prescribing workflow procedure. It will be the perfect decision support for the electronic prescriptions when implemented with real-time auto determination.

3- Retrospective PA

Once the claim rejection has happened most of the time the PA will not happen again. The prescribers will be able to adopt to the prospective workflow system. It will help them to get rid of the formal data challenges. It might take some time but soon the electronic PA will be able to provide the pharmacists to connect with the prescribers workflow with the EHR system.

4- Financial model

Once the prescribers will adopt to the PA system it will allow them to save billions of dollars. The biggest attraction of the PA is the ubiquity it provides and the prescribers will not have to pay anything for the technology.

5- Open application programming interface

In order for the software programmers to allow the prescribers to communication, they will have to follow the rules and regulations of API. Different software programming platforms will be used to interface with each other.

The developers are looking for the solutions that will make it easier to utilize the system. They will be able to quickly implement the solutions for the betterment of the market.

Some stats regarding Prior Authorization

Some of the important values that you have to consider regarding the Prior Authorization are:

• A nurse on a single physician per week spends 13.1 hours for PA and 3.8 hours on the formalities. With an electronic system, most of this time will be used for the patient care.

• 90% of the requests related to PA is operated through the phone which requires $2000 to $14,000 per year by a physician. The amount required by the electronic system is only 2 to 4%.

• The nurses will be able to avoid all the problems effectively.

Bottom line

You might be wondering that if there are so many benefits of Prior Authorization then why most of the authorities do not use the electronic system. The reason is that most of the system is still under development and they engineers are working to assure that they will provide the best quality to the pharmacies and the prescribers.

Within a few years when all the issues with the system will be resolved, it would become the most important solution that pharmacists will be looking for. The healthcare system that has installed the latest system in their working platform are enjoying the benefits.

They say that it has enabled them to pay more attention towards the requirements of their patients. There is no need to deal with writing down everything because with the help of the technology they can easily share the prescriptions with the pharmacists and they will provide the patients with the right medications once they reach the pharmacy.

It is important that we give this electronic system a chance because we will know its value only if we will try it. There are many other software available that are helping the medical fields but none of them has gained the importance like the electronic PA.

Workflow Management & Optimization handles prior authorization for physicians in order to obtain approval from their patients’ health insurance plan to verify that a certain drug, procedure, or service is medically necessary BEFORE it is done.

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Saqib Ayaz
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