Knowledge Center

Technology limitations, lack of stakeholder adoption and lack of mandated standards identified by health care providers, payers and vendors

WASHINGTON, D.C. — January 23, 2020 — WEDI, the nation’s leading nonprofit authority on the use of health IT to create efficiencies in health care information exchange and a trusted advisor to the U.S. Department of Health and Human Services (HHS), presented prior authorization (PA) survey results during testimony late last year before the HHS National Committee on Vital and Health Statistics (NCVHS). In the meeting, Jay Eisenstock, Chair of the WEDI Board of Directors, shared how the results highlighted technology limitations, increased PA requirements and the desire for mandated standards.

The survey, conducted by the WEDI Prior Authorization Subworkgroup in August 2019, analyzed the current medical services’ prior authorization process and will be used to develop guiding principles to support increased automation and standardization. The survey was distributed by WEDI to member and non-member organizations and received 127 total responses including 65 from providers, 31 from payers and 31 from vendors. An infographic of the survey results can be found here.

“The efforts of the WEDI Prior Authorization Subworkgroup not only help to guide future regulations but provide an important examination into existing processes as our nation’s providers, payers and vendors navigate the evolving requirements of prior authorization,” said Eisenstock. “While the industry has made great progress, this survey shows how much more work there is to be done to clarify and standardize prior authorization workflows. In fact, our colleagues at ONC continue to drive this conversation with the topic being a key point of discussion during last week’s Health Information Technology Advisory Committee (HITAC) meeting.”

Among key findings of the survey:

Trends in PA volume

• 84% of providers reported the number of medical services that require PA has increased
• 55% of vendors reported the number of medical services that require PA has increased
• 42% of payers reported the number of medical services that require PA has increased

Determining whether a PA is required without initiating a PA request is difficult

• 62% of providers reported they DO NOT have a technology to evaluate whether a PA is required without initiating a PA request
• Only 45% of vendors reported having technology to evaluate whether PA is required without initiating a PA request

Results of the survey were also presented during a December briefing on Capitol Hill, where a panel of WEDI experts addressed policymakers and federal agencies to announce emerging automation trends that can reduce PA challenges, lower costs and improve patient care. Panel participants included Jay Eisenstock; Heather McComas, Director, Administrative Simplification Initiatives, American Medical Association; Sagran Moodley, Senior Vice President, UnitedHealthcare, Chair, DaVinci Project, Chair DRLS/CMS; and Jon Zimmerman, CEO, Holon Solutions.

About WEDI
WEDI is the leading authority on the use of health IT to improve health care information exchange to enhance the quality of care, improve efficiency, and reduce costs of our nation’s health care system. WEDI was formed in 1991 by the Secretary of HHS and was designated in the 1996 HIPAA legislation as an advisor to HHS. WEDI’s membership includes a broad coalition of organizations, including: hospitals, providers, health plans, vendors, government agencies, consumers, not-for-profit organizations, and standards development organizations. To learn more, visit www.wedi.org and connect with us on Twitter and LinkedIn.