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Prior Authorization – A Burning Problem in Need of a Solution

[fa icon="calendar'] Apr 20, 2021 12:52:49 PM / by Lynda Rowe posted in FHIR, HL7 community, interoperability, Da Vinci, value based care, prior authorization, FHIR Accelerator, FHIR Implementation Guides

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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.
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Upcoming Da Vinci & HL7 FHIR Event Provides Keys to Payer-Provider Data Exchange Business Transformation

[fa icon="calendar'] Apr 13, 2021 12:36:03 PM / by Fred Bazzoli posted in FHIR, HL7 community, interoperability, Da Vinci, FHIR Accelerator, FHIR Implementation Guides

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Whether Attendees are Novices or Experts on Implementation Guides, Education Will Increase Knowledge and Build Community

Communicating the value of HL7’s Fast Healthcare Interoperability Resource (FHIR®) in healthcare isn’t always easy. Do you tell the story in purely technical terms? Describe the problems it’s intended to solve? Or offer examples of where it’s providing benefits?

The upcoming Da Vinci Education & HL7 FHIR Implementation Event addresses all of those questions for a variety of audiences.

The presenters at the virtual event, scheduled for the week of April 26 to 30, will explain the sense of urgency that underscores the need to accelerate adoption of FHIR-based use cases. They will also provide real-world context to show that these use cases are not just a theoretical construct, but are providing immediate benefits to those organizations that are using it to power the shift to value-based care.

The adoption of FHIR is picking up speed because of this growing recognition of its benefits in reducing clinician burden, improving the exchange of quality measure data and enabling real-time access to data by patients, providers and payers. The adoption of FHIR-based use cases also provides a way for organizations to meet federal rules governing interoperability and patient access to their medical information.

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