The Future of Prior Authorization: Prescription Trends and Forecasts for Healthcare Practitioners

Prior Authorization (PA) is without doubt one of the PA processes that is important in the healthcare reimbursement system, but it’s been problematic due to perceived ineffectiveness and high administrative workload over the years. One thing stands true though, with transformation in the environment, transformations in processes such as PAs are set to transition into new forms. With the quest to cut costs, serve patients better, and improve productivity, modernization of prior authorization is on the horizon. It is essential for healthcare providers to keep up with these advancements to ensure timely reimbursements without jeopardizing their revenue cycle management (RCM) strategies.In this article, we will discuss the principal trends and forecasts regarding the future of prior authorization, as well as what healthcare practitioners should do to prepare to these changes.

Evaluating the Current State of Prior Authorization

Before discussing the future of prior authorizations, it is important to speak on the current state of this topic. Prior authorization is a process done by insurers that require permission before patient specific services or treatments can be cured. Its main function is to contain costs and ensure that treatments recommended are essential. Retrospectively, prior authorization sometimes results in treatment delays and operational inefficiencies. Research indicates that substantial amounts of manpower and expenditure are incurred by healthcare facilities, some estimates report that providers use approximately 15 minutes for each request. The treatment delay phenomena, patient displeasure, and occasional claim denial all have negative effects on the revenue cycle of the practice.

Major Trends that Will Impact PA in the Future

Several upcoming trends drive the further development of prior authorizations, most of these aim to improve the effectiveness and the patient experience. Priorities of these trends’ needs to be set by healthcare players in order to streamline their operations which will in the end enhance their profitability.

1. The Move Towards Automation and Artificial Intelligence (AI)

The shift towards automation and AI is the most important advancement causing changes to prior authorization processes. Tools that automate and AI/ML-based systems are already present to assist submission of prior authorization requests to reduce administrative work and cut down errors. These technologies allow for the checking of eligibility, documentation generation, and prerequisite approval submission automatically to occur in real-time. Less human interaction leads to faster approvals, lower rates of denial, and lightened duty for staff. AI use can also be particularly beneficial in predicting the necessary approval rates based on historical data so as to enable decisions to be made based on data.

Benefit:

→ Reduced processing time

→Fewer errors and denials

→Enhanced operational efficiency

2. Integrating with Electronic Health Records (EHRs) and Other Health Information Technology (IT) Systems

With the increasing adoption of electronic health records (EHR) and other health IT systems by healthcare providers, the integration of prior authorization processes with these systems is becoming a priority. The capability to directly integrate with EHR systems will allow healthcare providers to make prior authorizations without leaving the practice management system of their clinic. The seamless communication among the provider, patient, and payer has been enhanced because there is no longer a need to duplicate data entry with the use of integration. In addition, the chances of approval for prior authorization requests have improved as there is more relevant clinical data available.

Benefit:

→ Reduced administrative burden

→Workflows are more streamlined

→Data accuracy has improved

3. Authorizations are Approved in Real-Time

Today, many prior authorization requests can take days to even weeks to get approved and processed. However, the future of prior approvals seems to lean on the possibility of real time or near real time approvals. These changes are driven from the need of better decision making and patient care. Healthcare providers will be able to provide timely treatment to people without feeling burdened by lengthy authorizations, enhancing patient satisfaction. It would also help them eliminate unnecessary procedures and ensure timely decision making because there is no longer a delay in approval systems. This means that more patients can be helped while providers save time and resources.

Benefit:

→ Bringing transparency to the process

→ Clear tips on operational communications

→ Positive changes in Internal and External Stakeholders Relations

4. The prior approval process is expected to become more refined and efficient over time.

Many healthcare providers experience irritation and anger concerning prior authorization approvals due to the complex procedures involving many ‘not-so-well-articulated’ step processes. With time, the hope is that insurers will be much clearer on what they want, put forth detailed information on what is expected to get approval, and why some requests for consideration are turned down. Clear communication aids in working united, which makes it easy to solve problems and revocations of authorization swiftly.

Benefit:

→ Modified tactics

→ Issue solving skill improvement

→ Better payer-provider collaboration

5. Health care providers have long been complaining about the absence of standardization in different insurers.

 With the request for the need to have a more orderly and efficient way to handle prior authorization, all providers keep on expectantly waiting for this change. Each contractor has their own sore of demands, forms, and ways of dealing with the previous endorsement. This has been the bane of many providers. The implementation of a unified process would eliminate the complications associated with constantly changing methods that affect how healthcare providers submit requests for authorization, which would lead to less administrative work and a reduction in errors made. A less drastic approach to prior authorization would also prove advantageous for the patients as they would not require extensive support in order to receive the help on time.

Benefit:

→ Streamlined processes

→ Lowered incidence of administrative errors

→ Enhanced patient satisfaction

6. Telemedicine and Remote Care: Effects on Prior Authorization

The expansion of telemedicine and remote healthcare services has introduced new barriers for prior authorizations. The introduction and expansion of telemedicine will require a shift in how healthcare providers issue prior authorizations, as they will need to account for remote appointments, prescriptions, and treatments.In the future, healthcare providers may see a less complicated approach to issuing prior authorizations for telemedicine services. It is possible that payers will create tailored strategies that deal with the specific challenges posed by remote care, so that virtual treatments and services can be approved expeditiously.

Benefit:

→Improved telemedicine credentialing processes.

→Quicker acceptance rates for remote consultations.

→Widening of patient access to services.

→Future Aliocations for Priors Authorisations

7. Increasing Expectation on Person-Centric care

Over the years, the strategy of prior authorisation is likely to be more patient-centric. This may be achieved through greater flexibility in treatment alternatives on the part of the insurers, thereby eliminating unnecessary administrative barriers, so that patients receive the required services. While reducing delays and focusing more on care delivery, prior authorisation will become a more palatable construct for the patients.

8. Adoption of Blockchain technology for efficiency and Accountability

New technologies such as blockchain can enable highly secure data management, and more transparent and accurate transactions which can enhance prior authorization. With blockchain technology, providers and payers can build a more secure, open, and accurate system for managing prior authorization that is less vulnerable to tampering, which can enhance trust among the parties.

9. Increase in Value-centered Management Models for Institutions

With a shift in the industry towards value-based care, there is reason to believe that prior authorisation will also change in form and content in order to fit this model. For example, insurers may place greater emphasis on services that achieve positive patient results and preserve overall expenditures, instead of rigidly following treatment protocols; this may make the process of prior authorization less stringent and more favorable towards value-based care.

How Prior Authorization Will Change in the Future and How Providers Can Prepare Themselves

1. Integrate Automation:

Invest in an automated system for prior authorization to minimize administrative spending and make the workflows much smoother.

2. Improve Data Integration:

 Integration of your EHR and practice management software with the payer side will help increase data efficiency and accuracy.

3. Strengthen Communication with Payers:

Having stronger relationships with the insurers will help in resolving prior authorization issues rapidly.

4. Educate Your Workforce:

 Ensure that your staff remains up-to-date with the ever-evolving policies and technologies with regards to prior authorization.

Healthcare systems can benefit from pre-authorization policies that are more efficient, faster. Providers will be able to stay focused on providing patients with better quality care by removing bureaucratic constraints that post approval policies create such as paperwork, calls, and all the waiting. Automation, superior communication, and new technology will be essential to accomplish these drastic changes. Are you looking to enhance your practices prior authorization system? Come talk to TechCare Global here at TechCare Global and see how we can streamline your revenue cycle and increase your profits.