WASHINGTON, D.C. – March 24, 2021 – Electronic prior authorization (ePA) can significantly reduce the time between a request for prior authorization and a decision and the time to a patient receiving care. These were two of the top findings from an initiative launched by America’s Health Insurance Plans (AHIP) to better understand the impact of ePA on the prior authorization process.
“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.”
AHIP launched the Fast Prior Authorization Technology Highway—or Fast PATH—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.
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The 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.
The study found that 71% 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%.
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% of experienced users reported fewer phone calls while 62% of experienced users reported less time spent on phone calls
58% of experienced users reported fewer faxes while 63% reported less time spent on faxes
Improved transparency of prior authorization requirements for providers who implemented ePA
60% of experienced users said electronic prior authorization made it easier to understand if prior authorization was required.
