Medical Economics October 6, 2022
Study looks at how prior auths help and hurt health care – and how they can be made better
A study from the University of Colorado and Johns Hopkins University on the prior authorization process for Medicare Advantage plans identified several areas for improvement.
The study, published in JAMA, examined the benefits and problems with prior authorizations, which 99% of MA plans use for at least some medical services. The goal of prior authorization is to ensure appropriate use criteria are met and the right care is provided to the patient to reduce unnecessary spending. This also can benefit the patient through reduction in premiums and lower out-of-pocket costs through better care allocation and reduced denials. The study also notes...
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