Articles | June 30, 2023
Our latest short quarterly insight on healthcare news for plan sponsors focuses on strategies for evaluating prior authorization (PA).
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This issue of Trends also includes a compliance reminder to stay on top of all the ACA dollar amounts and percentages for group health plans.
According to an American Medical Association (AMA) survey:
PA is intended to control costs and ensure appropriate use of healthcare services. It’s become a lightning rod for complaints by doctors, patients and even lawmakers. Done badly, PA can lead to increased plan costs and even adverse health outcomes for plan participants. However, if plan sponsors take a more active role in monitoring how PA is used in their group health plan, PA can achieve good results for the plan’s participants.
Inefficiencies in the PA process can lead to overutilization of healthcare services as well as patient delays in receiving necessary services. As noted, a recent survey of physicians by the AMA reported unintended outcomes. Areas requiring closer examination include:
Several reforms and initiatives have been undertaken to improve the PA process.
To enhance PA, plan sponsors can consider the following steps:
To stay on top of all the ACA dollar amounts and percentages for group health plans, see our June 8, 2023 insight.
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This page is for informational purposes only and does not constitute legal, tax or investment advice. You are encouraged to discuss the issues raised here with your legal, tax and other advisors before determining how the issues apply to your specific situations.