AHIP Tests Automated Prior Authorization Initiative

by Jane Anderson

Health insurer trade group America's Health Insurance Plans (AHIP) is partnering with six insurers to test systems and technology designed to automate parts of the prior authorization process in a bid to develop best practices.

The initiative, which AHIP calls the Fast Prior Authorization Technology Highway, or Fast PATH, will run for six months, during which AHIP and its partners will collect data to be used for an evaluation of the processes and technology used. The trade group will attempt to determine how much money and time an automated system saves providers and insurers.

Both providers and insurers are affected by cumbersome manual prior authorization procedures, although they don't necessarily agree on what will fix the problems. Insurers say prior authorization is necessary and promotes good patient care, while physicians maintain prior authorization leads to worse outcomes in many cases.

In a search for common ground, AHIP joined with other industry stakeholders, including providers, two years ago to produce a consensus statement that laid out core principles for addressing prior authorization issues. Federal lawmakers also have considered requiring electronic prior authorization.

As for AHIP's pilot, "the effect will be marginal at best as the small scale of this effort means physicians won't see a material impact," says Joe Paduda, principal with Health Strategy Associates LLC. "However, it may earn some good will."

The Fast PATH pilot will address two common but critical prior authorization processes: approval for certain prescription medications and approval for medical and surgery procedures. The initiative will use technology from Surescripts for the prescription component of the project and from Availity, LLC, for the medical and surgical procedures authorization piece.

The program will help to determine what types of automation solutions have the potential for widespread adoption, and how much they might improve practice workflow. Insurers participating in Fast PATH will include: Anthem, Inc., Blue Shield of California, Cambia Health Solutions' affiliated health plans, Cigna Corp., Florida Blue and WellCare Health Plans, Inc.

From Health Plan Weekly