Why Outsourcing is the Best Approach to Prior Authorizations

As healthcare continues its acceleration toward value-based reimbursement models, payers may begin to require even more PAs as they seek greater cost controls.

The industry has responded to this perceived burden with potential solutions that range from technology investments, like automation, to consensus statements from industry stakeholders that promise reforms to the authorization process.

Effective automation is as much about good business process design as it is about the technology. There are multiple factors to consider, including systems use, business impact, data touchpoints, return on investment of labor, and investment. Accomplishing effective automation in the face of lean IT and operational budgets is extraordinarily difficult. Personnel is another issue, as authorization staff are vulnerable to high rates of turnover and, as discussed below, finding employees with the required knowledge and skillsets.