Operational Tactics to Manage Prior Authorizations in Health-System Organizations

Prior authorizations for medical care were established in the 1960s when increased scrutiny on healthcare service utilizations began with the creation of Medicare and Medicaid governmental programs. This cost-containment tool has expanded to all parts of healthcare and has morphed from a well-intended effort to curb rising costs of care to a barrier to timely and appropriate care for patients. While prior authorization practices have received more recent attention at various state legislative forums, there are still significant areas for improvement.

The Institute of Medicine's Quadruple Aim is to enhance the patient's experience, improve population health, reduce healthcare costs and improve the work-life of healthcare providers. By adding attention to this currently required yet costly administrative burden to front-line clinicians who otherwise would be providing value-added patient care, healthcare executives will not only positively improve their staff job satisfaction but also see an improvement in their financial return on investments. This session will provide a background and timeline for improvements in the prior authorization process at a free-standing pediatric academic medical institution; describe lessons learned from this process improvement for attendees to use at their respective organizations; share provider experiences with how current prior authorization processes are a contributor to provider dissatisfaction and burnout; create a forum in which participants share their own experiences with prior authorization to foster best-practice sharing; and provide resources and tools that attendees can use to implement and refine their organizational processes. The use of the forum-sharing format as well as two methods implementing tactics to addressing prior authorizations barriers across a health-system will provide tangible takeaway tools to aid institutions in pursuit of the IOM Quadruple Aim.

Learning Objectives:

• Design and implement a strategic and structured implementation of processes to improve the prior authorization processes at a health system.
• Discuss various tools to facilitate the improvement of the prior authorization processes barriers across a health system.

Speakers:

Richard K. Ogden, Jr., PharmD, FACHE, BCPS
Director, Ambulatory Pharmacy Services
Children's Mercy Kansas City

Continuing Education Credit

ACHE Qualifying Education Credit

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Interprofessional Continuing Education Credit

In support of improving patient care, the American College of Healthcare Executives is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), the American Nurses Credentialing Center (ANCC), and the American Academy of PAs (AAPA) to provide continuing education for the healthcare team.

This activity was planned by and for the healthcare team, and learners will receive a maximum of 1 Interprofessional Continuing Education (IPCE) credit for learning and change. For further information about Joint Accreditation credits and certificates, please click here.

Physician Continuing Medical Education

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Continuing Pharmacy Education

The American College of Healthcare Executives designates this knowledge-based activity for a maximum 1 contact hours of continuing pharmacy education credit. 

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Physician Associate/Physician Assistant Continuing Education

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