Burdensome manual processes and inconsistent regulations continue to mar prior authorization processes despite a trend toward value-based care. However, a recent Chilmark Research report predicts improvements in automation solutions and payer-provider collaboration will transform the prior authorization process in the next five years.
Jennifer Rogers, senior analyst at Chilmark — a Boston-based research and advisory firm in the healthcare IT solution market — conducted briefings with 11 vendors for the report. Ms. Rogers also performed a secondary research review to examine prior authorization technology entering the market.
Here are three takeaways from the report.
1. Prior authorization is "on the cusp of having a breakout moment," Ms. Rogers said. In 2017, Chilmark estimates providers and payers will increasingly see new solutions broadening prior authorization's role in revenue cycle management, cost containment and population health management.
2. Providers' growing adoption of value-based care agreements is partially fueling the rise in prior authorization solutions. Technological advances in application programming interfaces, natural language processing and artificial intelligence are also part of the emerging prior authorization model.
3. Ms. Rogers estimates greater provider and payer convergence will feed prior authorization changes as well, and both parties will benefit from new tools and solutions.
To view the report, click here.