Later Monday afternoon, health officials held a press conference to highlight a new pledge by the insurance industry to streamline prior authorization processes.
The bottom line: Big insurers committed to six reforms aimed at reducing red tape, simplifying decisions, and improving transparency. These included:
- Standardized use of electronic prior authorizations with the Fast Healthcare Interoperability Resources (FHIR).
- Reduction in the number of services subject to prior authorizations by 2026.
- Ensuring medical professionals review all clinical denials.
The backdrop: Insurers have historically used tactics like prior authorization to interfere with patient care.
- CAP’s recent report on insurer interference highlights how health plans narrow networks and reduce coverage.
What they’re saying: “Insurers must reduce the delays to patient care and the growing administrative workload on physicians by targeting policies like prior authorization,” said CAP President Donald Karcher, MD, FCAP. “We welcome the opportunity for continued dialogue to ensure that patient care is not delayed or denied.”
What’s next: More work is needed to ensure that patient care isn’t negatively affected, and that physicians can provide high-quality care in their communities.