Press release

New Fast PATH Initiative Aims to Improve Prior Authorization for Patients and Doctors

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Patients deserve access to the safest, most effective and
highest-quality care. To achieve that goal, health insurance providers
may use prior authorization – a systematic approach based on clinical
evidence and data that ensures patients receive safe and effective
treatments. Today, America’s Health Insurance Plans (AHIP), along with
several of our member insurance providers, is launching the Fast
Prior Authorization Technology Highway (Fast PATH)
initiative to
improve the prior authorization process.

Electronic prior authorization is becoming more available to physicians
but most still use manual processes to request prior authorizations,
despite the common availability of online submission portals – with 46%
of requests submitted by fax
and 60% requiring a telephone call. Fast
PATH
aims to employ technology in the physician’s office to improve
connections between insurance providers, doctors’ offices, and other
care settings. This new initiative will rely upon the proven automated
technologies of both Availity
and Surescripts
to speed prior authorization requests, responses, and information
exchange.

Participating Insurance Providers Include Leading Companies Covering
Tens of Millions of Americans

Participating in components of Fast PATH include a diverse set of
leading health insurance providers that collectively cover over 60
million Americans: Anthem, Blue Shield of California, Cambia’s
affiliated health plans, Cigna, Florida Blue, and WellCare.

“When patients do better, we all do better. Patients should receive the
right treatments and medications at the right time in the most effective
and efficient way,” said Matt Eyles, President and CEO of AHIP. “That’s
why we’re committed to reducing unnecessary burden, increasing patient
satisfaction and improving quality and outcomes.”

Fast PATH will address two common but critical prior
authorization applications – one focused on prescription medications,
and the other on medical and surgical procedures. Here is how they
will work:

1. Improving prior authorization for prescription medications. Using
Surescripts technology, critical information will be available at the
doctor’s fingertips while the patient is still in the office – informing
the prescribing process, reducing surprises at the pharmacy counter, and
making it more likely the patient will receive and take the medication.
Together, this should promote better patient outcomes.

  • When a doctor prescribes a medication through an electronic health
    record (EHR), they can immediately access the patient’s pharmacy
    benefits, know whether the specific medication requires prior
    authorization, and have the information to choose an alternative
    treatment that is clinically equivalent but more cost-effective and
    does not require prior authorization.
  • If the doctor prescribes a medication that requires prior
    authorization, the doctor can immediately submit the approval request
    through their EHR.
  • The doctor will also have access to the patient’s out-of-pocket cost
    for each drug, so the patient will know what to expect to pay when
    picking up the medication at their pharmacy.

2. Improving prior authorization for medical and surgical procedures. Using
Availity technology, doctors and surgeons can access a multi-payer
portal to simplify prior authorization requests that may be required for
a surgery or other procedure. The portal allows for easier communication
and faster approvals, thus speeding the delivery of quality care for
patients.

  • When care providers or their staff order a procedure for a patient,
    they will know immediately whether the procedure requires prior
    authorization based on the patient’s specific health insurance
    coverage.
  • If prior authorization is required, the provider can easily submit the
    necessary information through the Availity portal to fulfill the
    request, avoiding time-consuming phone calls and interruptions to
    patient care.
  • The health insurance provider will review the information, make a
    determination based on the patient’s coverage and treatment evidence,
    and send a response through the portal.
  • The provider and staff can also manage all of their prior
    authorization requests through the user-friendly dashboard in the
    portal.

Expert Partners to Advise Fast PATH Pilot Initiative and
Evaluate Results

To evaluate the results and gather key learnings on deploying these
technologies, AHIP will utilize RTI International (RTI). RTI is an
independent, nonprofit research organization with experts in a variety
of health care design, implementation and evaluation areas. Point of
Care Partners, a management consulting firm, is serving as an expert
advisor to the project. After six months of running the Fast PATH
pilot initiative, RTI will evaluate the improvements to the
patient-provider experience.

Alex Cowell, PhD, the RTI Engagement Leader said, “RTI is honored to
serve as the independent evaluator to AHIP on a critical topic that
affects patients and providers in support of higher quality and more
efficient care delivery.” AHIP will use the results to work with
doctors, hospitals, care providers, and other stakeholders on the
development of interoperability and electronic prior authorization.

The goal is to offer a voluntary approach that is scalable and can be
highly integrated with existing electronic health records systems. The Fast
PATH
initiative is another example of health insurance providers,
doctors, and health information technology vendors working together for
the betterment of patient care.

About AHIP

AHIP is the national association whose members provide coverage for
health care and related services to hundreds of millions of Americans
every day. Through these offerings, we improve and protect the health
and financial security of consumers, families, businesses, communities
and the nation. We are committed to market-based solutions and
public-private partnerships that improve affordability, value, access,
and well-being for consumers. Visit www.ahip.org
for more information.