Health care coalition seeks ways to improve prior authorization, timely access to care

Health care leaders, including physicians, pharmacists, medical groups, hospitals and health insurance providers, are collaborating to put forth a new industry-wide effort to simplify prior authorization processes and ensure safe, timely and affordable care, while decreasing administrative burdens, according to a press release issued by the AMA.

The coalition, consisting of the AMA, American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association, released a consensus statement that outlines their main priorities in improving prior authorization and patient-centered care.

Health care leaders from these organizations plan to lessen prior authorization requirements based on performance, adherence to evidence-based medical practices and participation in a value-based agreement for health care professionals. They will also work together to review the services and medications that require prior authorization regularly and enhance communication channels between health insurance providers, health care professionals and patients.

Additionally, the coalition vowed to ensure that changes in coverage, health insurance providers or prior authorization requirements do not affect the continuity of care for patients who are undergoing active or stable treatment. They also plan to speed up the adoption of national electronic standards for prior authorization, and make formulary information and coverage restrictions more transparent.

“This collaboration among health care professionals and health plans represents a good initial step toward reducing prior authorization burdens for all industry stakeholders and ensuring patients have timely access to optimal care and treatment,” Jack Resneck, Jr., MD, chair-elect of the AMA, said in the release.

Health care leaders, including physicians, pharmacists, medical groups, hospitals and health insurance providers, are collaborating to put forth a new industry-wide effort to simplify prior authorization processes and ensure safe, timely and affordable care, while decreasing administrative burdens, according to a press release issued by the AMA.

The coalition, consisting of the AMA, American Hospital Association, America’s Health Insurance Plans, American Pharmacists Association, Blue Cross Blue Shield Association and Medical Group Management Association, released a consensus statement that outlines their main priorities in improving prior authorization and patient-centered care.

Health care leaders from these organizations plan to lessen prior authorization requirements based on performance, adherence to evidence-based medical practices and participation in a value-based agreement for health care professionals. They will also work together to review the services and medications that require prior authorization regularly and enhance communication channels between health insurance providers, health care professionals and patients.

Additionally, the coalition vowed to ensure that changes in coverage, health insurance providers or prior authorization requirements do not affect the continuity of care for patients who are undergoing active or stable treatment. They also plan to speed up the adoption of national electronic standards for prior authorization, and make formulary information and coverage restrictions more transparent.

“This collaboration among health care professionals and health plans represents a good initial step toward reducing prior authorization burdens for all industry stakeholders and ensuring patients have timely access to optimal care and treatment,” Jack Resneck, Jr., MD, chair-elect of the AMA, said in the release.