Last year 79% of medical groups reported increases in prior authorization (PA) requirements, yet in 20231, some leading payers as well as CMS have announced plans to reduce PAs. Which way is this cornerstone health plan strategy headed?
At Medical Review Institute of America (MRIoA), we believe the trend in reducing PAs will continue. The burden of PAs for payers, providers and patients is well-recognized. In the modern era of healthcare, payers are struggling with both the administrative workload and potential dissatisfaction and abrasion with patients and providers that PAs can cause.
We’re helping clients optimize their PA program using data-driven insights to identify what payers need to PA and what they don’t. We enable health plans to manage a more targeted prior authorization list, which reduces over- and under-utilization, administrative burden, and member and provider frustration.
Using data is the key. The MRIoA PA Optimization Platform™ is powered by MRIoA Insights™, our proprietary utilization management (UM) analytics and benchmarking database, and backed by more than 10 million reviews. With benchmarking and analytics, MRIoA creates an updated, broader view of your PA program, and actionable recommendations your staff or our clinical resources can put into place. A typical plan with 100K commercial members realizes annual savings of $1.7 million. That’s a 7:1 ROI.
By Ben Peterson, Senior Director, Platform Analytics, Medical Review Institute of America