Escaping the Archaic Prior Authorization Quagmire Requires Modern Solutions

Prior authorization (PA) is a dangerous and expensive healthcare problem that impacts provider job satisfaction as well as delays treatment, which can frustrate patients and increase the likelihood of risks to their health.

When deciding how to tackle the PA conundrum, at the top of the list of things to avoid are any “solutions” that do little more than automate a broken system. Speeding up a flawed process does nothing more than accelerate failure. Thus, payers and providers should beware of solutions that appear to be add-ons to older, flawed healthcare software platforms. These are exercises in reengineering; not efforts to fix the fundamental problem with PA that long has been ignored by legacy healthcare software vendors.

Perhaps one of the greatest cases to be made about improved PA processes is the ability for payers and providers to move deeper into value-based care.