Those of us who have been in healthcare a long time know that prior authorization can been a challenge for both payers, providers, and patients. One might think it’s time to remove prior authorization altogether, but until we have consistent clinical practice across the entire US healthcare system, it’s very hard to justify.
The current processes create a huge burden for providers and payers, and cause delays – sometimes critical – in patient care.
Why is prior authorization such a thorny problem[i]?
- Prior authorization issues contribute to 92% of care delays
- Nearly all of provider care delays are associated with inefficiencies and administrative issues with current prior authorization
- Providers take 6 hours on average to complete these requests, which is the equivalent of two business days. Thirty-four percent of providers have staff dedicated exclusively to completing prior authorizations.
- The prior authorization process costs $23 to $31 billion per year in the US, according to a 2009 study published in Health Affairs.
- The health plan cost per manual prior authorization is $3.68, compared to $0.04 per electronic prior authorization, according to a 2017 Chilmark Research report.