Streamlining and Reimagining Prior Authorization Under Value-Based Contracts: A Call to Action From the Value in Healthcare Initiative's Prior Authorization Learning Collaborative.

Circulation. Cardiovascular Quality and Outcomes
Mitchell A PsotkaAmerican Heart Association Prior Authorization Learning Collaborative*

Abstract

Utilization management strategies, including prior authorization, are commonly used to facilitate safe and guideline-adherent provision of new, individualized, and potentially costly cardiovascular therapies. However, as currently deployed, these approaches encumber multiple stakeholders. Patients are discouraged by barriers to appropriate access; clinicians are frustrated by the time, money, and resources required for prior authorizations, the frequent rejections, and the perception of being excluded from the decision-making process; and payers are weary of the intensive effort to design and administer increasingly complex prior authorization systems to balance value and appropriate use of these treatments. These issues highlight an opportunity to collectively reimagine utilization management as a transparent and collaborative system. This would benefit the entire healthcare ecosystem, especially in light of the shift to value-based payment. This article describes the efforts and vision of the multistakeholder Prior Authorization Learning Collaborative of the Value in Healthcare Initiative, a partnership between the American Heart Association and the Robert J. Margolis, MD, Center for Health Policy at Duke University. We outli...Continue Reading

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Citations

Jul 21, 2020·Circulation. Cardiovascular Quality and Outcomes·Karen E Joynt MaddoxMadeleine Konig
Dec 15, 2020·JACC. Heart Failure·Ankeet S BhattJaved Butler
Jul 20, 2021·Journal of the American Medical Informatics Association : JAMIA·Julie C LauffenburgerMichael A Fischer
Sep 10, 2021·Health Services Research·Michael Anne Kyle, Austin B Frakt

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