Patients Shrug at Prior Authorization

You should know by now that hospitals and doctors hate prior authorization (PA) requirements by health plans. Providers blame PA for much of what’s wrong with the healthcare system. It’s just a matter of time before they suggest PA had something to do with the Kennedy assassination and what really crashed in Roswell, New Mexico.

If you know healthcare, and I think you do if you’re reading this blog post, you know the heated debate over PA has nothing to do with patients, or healthcare’s customers. It has everything to do with money.

Insurers don’t want to pay provider claims, so they (or their artificial intelligence-powered technologies) delay or deny PA approvals. Providers want insurers to pay in full and promptly regardless of whether the services they rendered were appropriate or not. After a lot of unnecessary back and forth, insurers pay most of providers’ original claims anyway.

Until now, no one asked patients what they thought about PA. Strange that no one asked them because they end up paying the bill, whether that’s through premiums, copays and deductibles, or completely out of pocket.

Four researchers with Harvard, McKinsey & Company, Stanford and the National Bureau of Economic Research must have thought the same thing. They decided to ask them. The researchers surveyed 1,005 patients about PA. For comparison purposes, they asked 1,010 provider employees and 115 commercial health plan employees the same questions.

The researchers designed the 70-question survey to capture four outcomes:

• Favorable opinions of the PA process
• Provider efficiency in handling the PA process
• Health plan efficiency in handling the PA process
• Burden level of PA

As it turns out, patients were far less distressed about PA than providers or health plans, according to the results recently in Health Affairs Scholar.

For example:

• 88% of patients said they have an overall favorable opinion of PA compared with 73% for health plans and 70% for providers.
• 87.4% of patients said provider PA processes were efficient compared with 34.3% of providers that said their own PA processes were efficient.
• 79.2% of patients said health plan PA processes were efficient compared with 61.7% of health plans that said their own PA processes were efficient.
• 33.7% of patients reported no burden from the PA process compared with 7% for health plans and 1.8% for providers.

“Patients are generally not dealing with PA often, let alone daily like many providers and private payers. Effectively, patients shift much of the effort to providers and private payers,” the researchers said.

Further: “Patients may not be as invested in changing the PA process as providers or private payers.”

That’s a polite way of saying ignorance is bliss. Maybe so.

But the study does support the idea that the PA battle between providers and payers is about money, not about patients, who could care less.

Thanks for reading.