A group that includes a major health plan trade group and several individual health insurance carriers has announced plans to simplify and automate the prior authorization process.
The group includes several large health insurers that cover more than 60 million Americans, including Anthem, Blue Shield of California, health plans affiliated with Cambia, Cigna, Florida Blue and WellCare. Health plan industry trade group American’s Health Insurance Plans is also involved, along with health IT vendors Availity and Surescripts.
Working together, these organizations are launching the Fast Prior Authorization Technology Highway (Fast PATH) initiative. The effort will address two key problems impacting prior authorization practices across the industry.
One of the goals of Fast PATH is to improve prior authorization processes for prescription medications. The partners will leverage Surescripts technology to make medical information available immediately to doctors for use during prescription decisions.
Using this approach, doctors will prescribe meds using an EHR, which will make the patient’s pharmacy benefits available immediately and list which meds require prior authorization. If the physician chooses to seek prior authorization for a medication, they’ll be able to submit such requests directly through the EHR.
In addition, Fast PATH is working to streamline the prior authorization process for medical and surgical procedures. Using a multi-payer portal backed by Availity technology, providers will have access to tools that simplify prior authorization requests. Health plans will review these requests and send a response via the portal.
To gauge the results of the program, AHIP has cut a deal with research firm RTI International, which will look at the impact of the project. AHIP is also working with firm Point of Care Partners, which will serve as an advisor to the project.
So, what shall we make of this news? My take is that despite the announcement sounding like the usual health IT proclamations, Fast PATH could conceivably be a big thing. If it’s implemented effectively, it could be seen someday as a turning point in how health plans see prior authorization.
In the past, it paid off for health insurers to not only impose prior authorization requirements but also make it awkward and even costly to obtain them. It’s an inelegant, blunt force-style approach to screening out expensive drugs and procedures but it’s doubtless been effective at restricting physician spending over time.
By this point, though, it would appear that prior authorization costs have risen to the point where they aren’t sustainable for the carriers. By streamlining this process, they’re not only diminishing physicians’ pain, they’re helping themselves. With such self-interest in play, health insurers are likely to make initiatives like Fast PATH work.