KLAS report: Surescripts' medication prior authorization innovations increase efficiencies

Surescripts, a health information network, shared the results of a new technology that enabled greater workflow efficiency and faster approvals for prior authorizations for prescription medications, featured in a new KLAS K2 Collaborative Case Study, Leveraging Innovative Technology to Streamline Medication Prior Authorizations.

The KLAS case study highlights key outcomes of a Surescripts-led collaboration with three organizations, including Cleveland Clinic, another healthcare system and a pharmacy benefit manager. Together, they conducted an innovative demonstration that leveraged clinical intelligence to advance electronic prior authorizations for prescription medications, supporting greater workflow efficiency while maintaining essential clinical integrity.

[Read more: Surescripts partners with TPG]

Key outcomes from the KLAS case study include:

• Reduction in approval time, leading to faster prescription access for patients: The healthcare organizations reported that with the previous, manual process, prior authorizations for GLP-1 medications took 15.0–20.0 minutes; with the automation, that time has dropped to an average of 0.5–3.0 minutes.
• Increase in automated approvals: 62% of approvals for in-scope medications (of which there are now over 20) are now automated, leading to 25% of applicable prior authorization requests being automatically approved.
• Improvement in provider experience: For in-scope medications, there has been an 88% reduction in appeals and a 68% reduction in denials caused by a lack of information.
• Decrease in physician abandonment rate: The percentage of requests for which physicians receive a question set for additional information but never complete it (i.e., the physician abandonment rate) has dropped from 31% to 25%.
• Improved efficiency: The automation has improved provider efficiency with administrative processes, giving providers more time to focus on patient care. It has also saved substantial FTE time, which can be repurposed to other tasks.

Obtaining prior authorization for prescription medications can be a necessary step for patients to leverage their health plan benefits for the treatments they need. However, the process often requires overburdened providers to complete multiple manual, time-consuming steps to track down clinical information, including sending faxes and making phone calls. A recent survey showed clinicians who prescribe, including 65% of physicians, physician assistants and nurse practitioners, as well as 57% of pharmacists, indicate that reducing administrative tasks would have the greatest positive impact on patient care and health, Surescripts said.

“We know that there is a heavy administrative burden for clinicians, pharmacies, and benefit plans related to medication-related prior authorizations,” said Tara Dragert, chief product officer for Surescripts. “Reducing the time spent sending faxes and making phone calls means clinicians can spend more time caring for patients, which is critical to how we are helping healthcare heal itself.”

According to the KLAS case study, Surescripts technology provided “automation [that] has reduced approval times, denial rates, and physician abandonment rates, resulting in quicker access for patients to needed medication.”

[Read more: Surescripts reports healthcare interoperability reached record levels amid pandemic]

“This project demonstrated the power of tackling shared challenges with innovative technology and cross-industry collaboration. And when trusted intelligence on benefits and authorizations is leveraged at the right time, patients get high-quality, affordable care sooner, creating a better experience that supports better outcomes,” added Dragert. “We thank the Surescripts Network Alliance members who participated and look forward to continuing to expand our impact and improving patient care together.”