Health Insurers Commit to Reforming Prior Authorization Process to Enhance Patient Care
Health insurers pledge to reform prior authorization, aiming to streamline patient care and reduce barriers to necessary medical services for millions of Americans.
Oz strikes deal with health insurers to reform prior authorizations
Washington Examiner
Overview
- Health insurers are reforming the prior authorization process to improve patient care and reduce delays in accessing medical services.
- The changes are a response to concerns that prior authorization is often used as a cost-cutting measure, impacting patient access to care.
- Approximately 1 in 6 insured adults have reported issues with prior authorization, highlighting the need for reform.
- Nearly 1 in 5 adults experienced prior authorization problems in the past year, prompting insurers to take action.
- The reforms could potentially benefit around 257 million Americans by making healthcare access easier and more efficient.
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Analysis
Center-leaning sources frame the prior authorization process as a significant barrier in healthcare, emphasizing consumer complaints and the need for reform. They express skepticism about insurers' promises, highlighting the prevalence of issues faced by insured individuals. The tone suggests a cautious optimism, urging accountability and genuine change from insurers.
Prior authorization is a cost-cutting measure used by health insurers that requires approval before patients can receive certain tests, procedures, or medications.
Approximately 1 in 6 insured adults reported prior authorization issues, with nearly 1 in 5 experiencing problems in the past year, according to a 2023 survey from KFF.
Health and Human Services Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services Administrator Mehmet Oz praised the insurance reforms during a Monday news conference in Washington, D.C.
Articles (4)
"…Health and Human Services Secretary Robert F. Kennedy Jr. said Monday that the country’s largest health insurers have promised to take steps to streamline the often-criticized prior authorization process, which can delay or deny patients’ access to care."
NBC News·14h·"…The large health insurers also will seek to standardize computer systems to process prior authorization requests."
USA TODAY·16h·"…The new commitments are aimed at speeding up and reducing prior-authorization processes used by insurers, a process that has been long-maligned for unnecessarily delaying patient care and other bureaucratic hurdles negatively impacting patients."
FOX News·14h·"…The insurance companies promised to reform their procedures for prior authorizations, the protocol a patient’s provider requires before it will cover specific services or treatments."
Washington Examiner·16h·FAQ
Health insurers are pledging to streamline prior authorization by standardizing electronic prior authorization requests by 2027, expanding real-time responses, reducing the volume of medical services requiring prior authorization by 2026 (including common procedures like colonoscopies and cataract surgeries), and honoring existing prior authorizations during coverage transitions.
The reforms are expected to benefit approximately 257 million Americans covered by Medicare Advantage, Medicaid managed care plans, Health Insurance Marketplace plans, and commercial plans.
The initiative includes specific standards, deliverables with defined metrics and deadlines, and oversight to ensure accountability, distinguishing it from previous unsuccessful attempts by insurers to reform prior authorization processes.
Prior authorization has often been used as a cost-cutting measure that causes delays and barriers to necessary medical services, negatively impacting patient access. Reform is critical as approximately 1 in 6 insured adults have experienced issues with prior authorization, highlighting the need to improve timely access to care.
Some lawmakers, such as Senator Marshall, have indicated that Congress might pursue codifying portions of the prior authorization reform initiative into law in the future, signaling possible legislative support to reinforce these changes.
History
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