I’m Telling You Right Now: It’s Time to Rethink Prior Authorizations

Healthcare is being transformed by technology, regulations and increased patient involvement in the clinical process. Federally mandated protocols, such as MACRA (Medicare Access and CHIP Reauthorization Act), are changing the care dynamic by requiring clinicians to report on patient satisfaction as a proxy for compensation. Value-based care has clinicians and administrative leaders hungry for timely and accurate data to guide planning and decision making.

All good stuff, but we’ve still got a lot of clean-up to do.

In view of the emerging new paradigm in accountable health care, I marvel that prior authorizations, which are time consuming and cumbersome, continue to be evaluated and processed in the same, old way.

The prior authorization process needs a big upgrade. It’s full of cobwebs and just takes too long. Insurance companies and clinicians must ask for more information to evaluate requests and it’s this extra step that results in inefficiencies, excess overhead and wasted time. All stakeholders – clinicians, providers, insurance companies and patients – suffer due to the onerous nature of prior authorization. Healthcare happens as a dialogue, but the prior authorization process is a huge industry gap that hampers progress in medicine and patient care.

We all agree that patient history, medical records and related documents are crucial to evaluating prior authorization, so why not enable and provide easy but secure access to current, accurate patient information at the time of the authorization request?

Secure Exchange Solutions is solving the prior authorization challenge by creating a common and open way to exchange information while reducing and, hopefully, eliminating needless overhead.

Early in 2017, we assembled a group of industry thought leaders whose collective knowledge and expertise in health information exchange could help address this pressing issue. Dubbed the “Innovation Messaging Taskforce,” we are, for the first time, working to combine multiple existing standards into a highly scalable work flow. Our immediate aim is to define and pilot this combination of standards.

Fueled by delivering solutions that address increasing industry needs, Secure Exchange Solutions climbed aboard the 2017 Inc 5000 list of the fastest growing companies in the United States, just announced. Since 2014, we have enjoyed 92 percent growth year over year, the direct result of our people and our commitment to overcome hurdles – such as the cumbersome prior authorization ordeal – to achieving optimal care at reduced costs in the current healthcare landscape.

We must improve the flow of patient information for everyone’s benefit, but in particular, patients who will suffer less pain, improve their quality of life, and live longer and healthier.

I’d welcome your thoughts.

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