Unlocking Efficiency: Why Your Practice Needs Electronic Prior Authorization

In today’s ever-evolving healthcare landscape, staying competitive and prioritizing patient care is more critical than ever. To achieve this, practices must embrace cutting-edge technology solutions.

In this healthcare tech market, Electronic Prior Authorization (ePA) has emerged as a game-changer, streamlining the authorization process and boosting efficiency.

Let’s explore why ePA is becoming a necessity for practices aiming to reduce administrative burdens, save time and money, optimize patient outcomes, and thrive in a competitive marketplace.

What Is Prior Authorization?

Prior Authorization (PA) is a practice enforced by health plans to ensure that specific services are approved before delivery, making patients eligible for coverage. While PA initially aimed to curb unnecessary services, current manual procedures sometimes hinder patient care access.

Larger practices, in particular, grapple with time-consuming PA processes, leading to treatment delays and suboptimal patient health outcomes.

Troubling Statistics on PA

An American Medical Association (AMA) survey revealed concerning statistics about PA:

• 82% of physicians feared that PA could lead patients to abandon treatment.
• On average, 64% of providers waited a full business day for PA feedback, with 29% waiting at least three days.
• 91% of physicians believed PA could cause adverse clinical outcomes.
• 34% claimed PA resulted in a serious negative event for a patient under their care.

The Hidden Costs of Prior Authorizations

While health insurers market PA as a cost-saving measure, the AMA survey exposed the flip side. Namely, that it can increase employee absences and disrupt workforce productivity when patients can’t get their medications or treatments on time.

On average, medical offices spend two full business days weekly on prior authorization requests, completing around 41 requests per doctor per week. As a result, 40% of providers must dedicate staff exclusively to PA tasks. And in 2019, PA processing costs reached a staggering $528 million.

Some insurance companies are trying to alleviate the PA burden, but challenges persist. UnitedHealthcare plans to eliminate 20% of existing prior authorizations for certain plan members, while Cigna has removed PA process reviews for nearly 500 services.

However, prior authorization remains a financial and operational challenge for physicians.

Changing the Game with Electronic Prior Authorization

Amidst efforts to decrease the PA burden, electronic prior authorization (ePA) has proven itself to be a frontrunner among the tools that have emerged.

This electronic feature enhances the process by transmitting authorization documents digitally, replacing outdated methods like fax or phone. What’s more, it can seamlessly integrate with Electronic Health Record (EHR) systems, enabling providers to request authorizations within their clinical workflows effortlessly.

How ePA is Transforming Patient Care

Electronic prior authorization streamlines processes like medication delivery by providing real-time authorization. The Fast Prior Authorization Technology Highway initiative, founded by America’s Health Insurance Plans, highlighted significant benefits of this revolutionary tool:

• 71% of providers using ePA reported faster access to quality care.
• The number of prior authorizations increased by 34%.
• The time between submitting a PA request and receiving a decision from a health insurance plan was reduced by 69%.
• 54% of users made fewer phone calls and 62% spent less time on the ones they did make.
• Providers experienced a significant reduction in the time required for transactions, with one third taking two hours or less, compared to 24% of PAs that used to take two days or more to complete.

Moreover, ePA slashes costs, particularly for multi-specialty practices. According to the Council for Affordable Quality Healthcare (CAQH), manually generating a single prior authorization request costs around $11, but ePA reduces this cost to less than half.

A complete shift to ePA could save the medical industry $355 million annually.

A Better Way to Care for Patients: ePA & EHR Integration

Despite some of the challenges that are still being addressed with electronic prior authorization, 83% of physicians have named ePA a top priority. And 64% support EHR vendors in providing streamlined prior authorization processes.

As healthcare professionals now seek easy, secure, and integrated ePA solutions, the answer lies in companies like CoverMyMeds.

CoverMyMeds offers seamless ePA integration within existing EHR platforms. This technology reduces patient wait times and allows providers to initiating new PA requests at the point of prescribing and electronically submit patient information and clinical questions to payers.

According to CoverMyMeds, patients can access their medications 13.2 days sooner when providers initiate prior authorization requests at the point of prescribing.

Recognizing the potential of this technology, iSalus is launching an integration with CoverMyMeds. This partnership ensures that providers and staff can enjoy secure and user-friendly ePA solutions within an integrated EHR platform, saving time, reducing administrative burdens, and ultimately delivering better patient care.

Interested in learning more or seeing the integration in action? Schedule a demo today!