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Revisiting Prior Authorization with Matt Gagalis

Back in October, we shared a blog post that explained prior authorization and the bill – H.R. 3107, the Improving Seniors’ Timely Access to Care Act of 2019 – that seeks to fix it. This bi-partisan legislation has not yet been approved, however, and prior authorization has remained a hot topic as the push for a streamlined and standardized process continues. JAMA recently published two Viewpoint articles regarding prior authorization – one from a physician’s perspective and the other from the patient’s perspective.

In the Viewpoint piece, “Refocusing Medication prior Authorization on Its Intended Purpose”, Dr. Resneck shares his perspective as a physician. He discusses the changes that have come to light over the years with respect to prior authorization for prescription medications. Interestingly, he suggests “balanced proposals” rather than an “unrealistic call to abolish prior authorization”. His proposals include a more focused approach, protection of care continuity and transparency.

In “Changing the Game of Prior Authorization: The Patient Perspective”, authors Gaines, Auleta and Berwick discuss prior authorization more broadly and the burden that these processes place on clinicians and patients. They address delayed care, surprise billing to patients and denials – including denials following initial approvals. Importantly, they call for new legislation to protect patients and hold insurers more accountable.

From CarePort’s perspective, prior authorization has evolved over time, and is likely not going to go away soon. However, there remains tremendous opportunity for the process to be optimized – and more aligned – with its initial objectives of improving outcomes, reducing cost, ensuring patient satisfaction, reducing inappropriate drug use and improving quality. To use Dr. Resneck’s words and “refocus prior authorization on its intended purpose”, a combination of technology and legislation is required. Prior authorization is a complex workflow, and CarePort solutions can help to streamline and improve the post-acute prior authorization process, reduce provider abrasion and improve rates of authorization success.

As highlighted in our previous blog post, CarePort ultimately believes that patient outcomes should be the priority. We always support efforts that ensure patients receive the appropriate level of care, as soon as that care is needed.

Interested in learning more on how CarePort can help you streamline the prior authorization process? Reach out.

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