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Published: June 25, 2015

Prior Authorizations may become less painful in value-based market

May 26, 2015 - Curant Health President & CEO, Patrick Dunham, in Fierce Practice Management - When it comes to practice-management headaches, the hassle involved in obtaining prior authorizations from insurers often leads the list of complaints. And while many elements of fee-for-service reimbursement structures will begin to disappear as the industry moves toward value-based care, this most-disliked task won't be one of them, according to a recent article from Managed Healthcare Executive.

"We literally just asked a gathering of payers and providers if the use of evidence-based criteria, utilization management and prior authorization are going to fade in the next three years or so, as a result of the move to value-based care and [accountable care organizations] and so on," Laura Coughlin, the vice president of clinical development with McKesson Health Solutions, recently told MHE. "They were fairly unanimous in saying absolutely not. That's because the desire to ensure that people are getting safe, effective, quality care is not going to go away."

As a result, payers may begin to require prior authorizations even more than they do now, especially as more expensive specialty drugs flood the market, noted Patrick Dunham, chief executive officer for Curant Health.

However, the use of such approval systems will evolve, according to experts. Importantly, authorizations will become much faster, even immediate, compared to the not-distant past when it could take up to 15 days to get a preauthorization, Coughlin said.

It may also be possible for practices to reduce the amount of time they spend on preauthorizations as part of the payer negotiation process, Lucien Roberts, a practice administrator for Gastrointestinal Specialists Inc., in Virginia, told Physicians Practice. If a practice can demonstrate that it does not overuse certain tests, he said, it may be able to argue that asking for a prior authorization each time is a superfluous use of the payer's staff time.

To learn more:
- read the article from Managed Healthcare Executive
- here's the article from Physicians Practice

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