Four Levers for Fixing Prior Authorization: Our Expert Comments to U.S. Department of Health and Human Services

To reduce the administrative burden for providers and improve patient care, the federal government is considering creating electronic standards for prior authorization. In a process that ended March 25, HHS’ Office of the National Coordinator for Health Information Technology (ONC) solicited comments on electronic prior authorization standards, implementation specifications and certification criteria that could be adopted within the ONC Health IT Certification Program.

Drawing on extensive experience optimizing prior authorization for health plans and providers, COPE Health Solutions recommended four levers for developing streamlined, digital prior authorization processes that are both patient-centered and efficient.

  1. Rationalize procedures subject to prior authorization.
  2. Standardize the request process.
  3. Require digital portals and self-service.
  4. Accelerate approvals using automation.

For more details on how to apply the four levers, please read our letter to ONC.

As part of an upgrading of US Family Health Plan’s medical management programs including utilization management, care management and quality of care, COPE Health Solutions made prior authorization faster and easier with an online provider portal and reduced procedures requiring prior authorization by two-thirds. Check out the case study.

If you’re interested in learning more about streamlining prior authorization or improving medical management, please contact us at info@copehealthsolutions.com.

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