Moving beyond prior authorization

Once used sparingly by insurers to ensure treatments were clinically appropriate, prior authorization has created barriers to treatments ranging from heartburn medications to chemotherapy. Increasingly, prior authorization results in friction between physicians and payers, leaving patients under-served and at risk. This current dilemma is a byproduct of fee-for-service medicine, which is based upon payment for every patient visit, treatment or test performed, regardless of health outcomes.

By contrast, Permanente physicians are empowered to provide the optimal clinical care for and with their patients. That’s because our prepaid, integrated model combines health plan coverage with coordinated medical services to reward healthy outcomes while making care more affordable. It embraces medical evidence, focuses on preventive care, aims to reduce the burden of chronic disease, and fosters collaboration among physicians, specialists, and other medical professionals. Practicing evidence-based medicine at an individual and population level allows our physicians to seamlessly prescribe a treatment, order medications, consult with an expert and refer a patient to a specialist. Our value-based model holds physicians and their teams accountable for both quality and cost by delivering the right level of care at the right time.

Wide adoption of value-based care is the alternative to the daily frustration physicians, patients, and insurers are experiencing with the old ways of approaching care. Despite spending more on health care per person than other developed countries, the U.S. ranks last on access to care, administrative efficiency, equity, and health care outcomes. Prior authorizations exacerbate these challenges. By one estimate, the U.S. spends about $35 billion annually on prior authorizations – about what it costs to provide health care to those without health insurance.

We can create a new path and reality.  Value-based care provides a blueprint to improve quality, outcomes, and costs, while moving away from inefficient prior authorization processes.