Prior-Authorization Solutions

Executive Dialogue

Automating workflows to reduce the burden on clinicians and patients

Inefficient prior-authorization processes, slow turnaround times, lack of transparency and inconsistent requirements by payers can lead to dangerous delays in patient access to needed care and are a significant burden on physicians and patients. By making the prior-authorization process more transparent and connecting it to the point of service, clinical decision support and real-time pharmacy benefit checks can be used to inform clinicians at the point of care whether prior authorization is necessary. Some hospitals and health systems are working to automate parts of the authorization process, but they face significant challenges that can only be addressed by working jointly with payers. One of the most frustrating aspects for providers and patients is the variation in prior-authorization submission processes. Ensuring standardization across payers is crucial to automating authorization processes.