Dr. Catherine Gaffigan: System safeguards patient safety, controls costs

“Should Indiana prohibit prior authorization in health care?”

In my two decades in health care, prior authorization has become an easy target even though it serves the crucial purpose of ensuring that patients receive safe, evidence-based and cost-effective medical care. Prior authorization also helps prevent fraud, waste and abuse, and keeps costs from reaching untenable levels.

Designed to be a safeguard against inappropriate or unsafe medical practices, prior authorization ensures that treatments and medications are scientifically validated. Plus, in a system where patients often receive care from multiple providers, prior authorization acts as a care-coordination tool. It double-checks proposed treatments for medical or medication errors, safeguards against dangerous drug interactions, and verifies that prescribed devices and medications are FDA-approved and have a low potential for misuse. Through its processes, prior authorization contributes to a health care system that prioritizes patient safety and adheres to best practices.

Elevance Health’s family of brands, including Carelon Health, are proactively adopting digital solutions to expedite the prior authorization process. Historically, most requests were processed via phone, mail or fax. Today, innovations such as real-time prior authorization submission and workflow services significantly accelerate the process. For example, approximately 70% of prior authorization requests handled by Carelon Medical Benefits Management for Elevance Health’s network are approved instantly, and 95% are finalized within 24 hours.  This rapid turnaround mitigates the risk of unnecessary delays and ensures patients receive prompt care.

Elevance Health is also committed to collaborating with health care providers to streamline prior authorization and find solutions that support both patients and providers. For instance, studies show that electronic prior authorization can save providers an average of 11 minutes per request. Multiplied across the health care system, these savings could potentially equate to $449 million annually, proving that efficiency and safety are not mutually exclusive but are complementary goals.

The elimination of prior authorization in Indiana would be a regressive step. Instead, the focus should be on modernizing this essential tool through digital solutions and robust provider partnerships. Elevance Health’s initiatives to enhance prior authorization through secure data exchanges aims to speed up the process while ensuring a health care system focused on quality, safety and cost-effectiveness.

Indiana should look to the future—one where prior authorization evolves through technology and collaboration to help create a more effective and patient-centered health care experience.•

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Gaffigan is president of health solutions for Elevance Health. Send comments to ibjedit@ibj.com.

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