Tackling Prior Auth: New Solutions to Address Provider-Payer Friction

by | Jul 25, 2017

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Watch lead analyst Jennifer Rogers’ webinar that accompanied the release of this report:

PA solutions are on the cusp of a breakout moment, partially driven by both the growing adoption of value-based care (VBC) arrangements, as well as sophistication of new enabling technologies, including APIs, NLP, and AI. A new PA model is emerging that promises to deliver mutually beneficial results for providers and payers with far less pain, better-integrating CDS, claims, and order workflows at the point of care.

With the dubious honor of being one of the thorniest pain points in provider-payer collaboration, and sitting at the start of the revenue cycle, PA is a logical starting point to establish greater provider-payer convergence. Chilmark Research projects that this new evolution in PA technology will serve as a petri dish for greater forms of convergence that will then spread to other VBC strategies.

This report answers the following questions:

  • How is PA evolving for providers and payers alike, given the growing expansion of VBC adoption?
  • What is the current state of pharmacy and medical PA technology and process?
  • Who is innovating in this space to improve the provider-payer experience and clinical and cost outcomes?
  • What should healthcare organizations (HCOs) consider as they decide on a solution?
  • Where do significant gaps remain that HCOs will struggle to fill?

Vendors Profiled: Accenture, athenahealth, Availity, Change Healthcare, Cognizant, CoverMyMeds, eviCore, MCG, Partners Healthcare, Surescripts, ZipRad

Cost: $2,750 (Discounts for qualified provider organizations. Email John for details.)

 

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