Automation of utilization management activities will enable patient-centered care, including within EHR technology for the purposes of streamlining e-prescribing.
That is the focus of new reform principles developed by the American Medical Association in partnership with other medical academies to reduce the cost and inefficiencies of prior authorizations.
As AMA and other associations note, prior authorization is part of the health plan cost-control process that requires providers gain approval before performing a service to qualify for payment. The process is necessary for pharmaceuticals, durable medical equipment, and medical services to attain from health insurers in order to proceed with treatment. However, the process is not very cost- or time-efficient, and delays in treatment can yield negative repercussions for patient outcomes.
AMA anticipates integration of these principles into the current prior authorization process will allow patients timely access to treatment and reduce administrative costs to the healthcare system.
According to the organization, these principles centered on clinical value, continuity of care, transparency and fairness, timely access and administrative efficiency, and alternatives and exemptions will yield favorable results. The 21 principles aimed at working toward achieving these overarching goals in prior authorization span five categories:
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