Empowering Health Plans and PBMs to Address the Prior Authorization Burden: Insights from Medical Groups

In response to the recent report from the Medical Group Management Association (MGMA), it’s evident that the prior authorization process remains a significant challenge for medical groups, impacting patient care and straining operational efficiency. The report highlights the pressing concerns around the prior authorization burden faced by medical groups, including delays, denials, and resource reallocation due to the surge in prior authorization requests.

Key Takeaways from the MGMA Report:

1. Widespread Impact: 89% of medical groups find prior authorization extremely burdensome, affecting practices of all sizes, with 97% reporting patient care delays or denials.
2. Operational Challenges: 92% of practices have adjusted staffing due to increased prior authorization requests, signifying a considerable administrative burden.
3. Top Challenges: Delays in authorization decisions (88%), prior authorizations for routinely approved items and services (83%), and inconsistent payer policies (80%) are identified as major obstacles.

Turning Insights into Action: How Health Plans and PBMs Can Address the Prior Authorization Burden with PAHub™:

1. Streamlined Processes: Agadia’s Prior Authorization solution, PAHub is designed to streamline the entire prior authorization workflow, significantly reducing delays and enhancing decision-making efficiency. Furthermore, to address the delay concerns around prior authorizations for routinely approved items and services, Health Plans and PBMs can leverage PAHub’s Auto-Decision feature, which enables the configuration of clinical criteria and decision trees in advance, allowing the allocation of staff to high-touch requests instead of requests that can be adjudicated automatically.

2. Administrative Efficiency: With PAHub, health plans and PBMs can alleviate the burden on staff and resources, optimizing operational efficiency and refocusing efforts on member care

3. Improved Member Care: By addressing the challenges highlighted in the MGMA report, PAHub ensures members receive timely and necessary care without unnecessary hurdles.

4. Enhanced Productivity: PAHub’s innovative features empower health plans and PBMs to optimize their prior authorization processes, ultimately leading to increased productivity and satisfaction.

What clients are saying about PAHub:
“We have directly benefited from the efficiencies afforded through the PAHub platform. We would not have been able to enhance the level of care we provide to our members while scaling our operations without the support of the Agadia software and team.” – Dr. Nathan Harold, RPh, PharmD., MedOne

In conclusion, the MGMA report serves as a wake-up call for Health Plans and PBMs to take proactive steps to address the prior authorization burden. PAHub emerges as the solution to not only meet these challenges head-on but to revolutionize the entire prior authorization landscape, delivering operational excellence and prioritizing member care. Health plans and PBMs can lead the change by adopting PAHub to address the concerns raised by medical groups and pave the way for a more efficient and member-centric healthcare ecosystem. Contact us today to schedule a demo.