By: TAHP | Thursday, April 1, 2021

April 1, 2021

By: Jamie Dudensing

Every Texan deserves the best health care possible—that means ensuring their care is safe, effective, and clinically appropriate. Prior authorization (PA) is the most important tool health insurance providers have to get patients that care. It reduces inappropriate care by catching unsafe or low-value care and targeting care that is not consistent with the latest medical recommendations—both of which contribute to potential harm and unnecessary costs for patients.

While Texas has some of the strictest requirements for PA response time—a maximum of three calendar days—outdated, paper-based systems can make the PA process burdensome. A top finding from an America’s Health Insurance Plans (AHIP) initiative, Fast Prior Authorization Technology Highway—or Fast PATH, shows that implementing electronic PA filing systems can reduce that burden by significantly reducing the time between a request being made and a patient receiving care.

AHIP launched the Fast PATH initiative to better understand how electronic PA could impact the process for patients and providers. Six health insurance providers that collectively cover over 50 million Americans participated in the project.

The initiative began in early 2020 and ran for approximately 12 months. The evaluation included analyzing prior authorization transaction data before and after implementation of electronic prior authorization and surveying providers on their experiences using electronic prior authorization technology.

The study found that 71% of experienced providers who implemented electronic PA reported faster time to patient care. In addition, electronic filing reduced the time between submitting a PA request and receiving a decision from the health plan by 69%.The greatest benefit for providers was seen by those who use technology for most or all their patients.

“Medication only works if patients can access, afford and adhere to it,” said Mike Pritts, Chief Product Officer for Surescripts, one of the technology partners in the study. “By working together across the industry to drive greater use of electronic prior authorization, we can eliminate phone calls and faxes, get patients started on treatment faster, and improve overall care by increasing medication adherence.”

The AHIP study helps confirm that electronic implementation is one of the most effective ways to improve the prior authorization process.

Click here for more information on prior authorization and the Fast Path initiative.
For more information about prior authorization and other ways to best utilize health care, visit TAHP’s policy page.