Perceptions of prior authorization burden and solutions

Abstract

Abstract The prior authorization (PA) process consumes time and money on the part of patients, providers, and payers. While some research shows substantial possible savings in the PA process, identifying what different groups can do is not as well known. Thus, organizations have struggled to capture this opportunity. To understand different perspectives on PA burden and receptivity to possible changes in the PA process, we surveyed 1,005 patients, 1,010 provider employees, and 115 private payer employees. Patients reported the longest perceived wait times but indicated the highest perceived approval rates and lowest perceived burdens. The relatively low burden for patients is because most do not have to engage in PA directly. Provider respondents reported spending time equivalent of more than 100,000 full-time registered nurses per year on prior authorization. Artificial intelligence represents a possible solution: 65% of private payer respondents reported that their organizations planned to incorporate it into the process in the next three to five years. Intended provider adoption is much smaller (11%). Private payer respondents cite cybersecurity concerns and a lack of technical infrastructure as barriers; provider respondents cite lack of budget and limited trust in the technology.