Perceptions of prior authorization burden and solutions.

Abstract

The prior authorization (PA) process consumes time and money on the part of patients, providers, and payers. While some research shows substantial possible savings in the PA process, identifying what different groups can do is not as well known. Thus, organizations have struggled to capture this opportunity. To understand different perspectives on PA burden and receptivity to possible changes in the PA process, we surveyed 1005 patients, 1010 provider employees, and 115 private payer employees. Patients reported the longest perceived wait times but indicated the highest perceived approval rates and lowest perceived burden. The relatively low burden for patients is because most do not have to engage in PA directly. Provider respondents reported spending time equivalent of more than 100 000 full-time registered nurses per year on prior authorization. Artificial intelligence (AI) represents a possible solution: 65% of private payer respondents reported that their organizations planned to incorporate AI into the process in the next 3 to 5 years. Intended adoption by provider respondents is much smaller (11%). Private payer respondents cited cybersecurity concerns and a lack of technical infrastructure as barriers; provider respondents cited lack of budget and limited trust in the technology.