It wasn’t quite billions of years ago, nor was it in a galaxy far, far away, but American health care services have been subjected to prior authorization processes for a very long time. Right now, prior authorization is a hot topic, so a number of entities have done a nice job explaining (see here, here) why there is a process to determine whether a medical service or product should be reimbursed by health insurance. It is certainly a pain point for doctors and patients — waiting for the nod from the guy with the wallet. So we were very interested in the recent piece by Mark Fendrick, a doctor and University of Michigan professor, who calls prior authorization “an important tool to ensure safe, clinically appropriate, and cost-effective care.” In the 1990s, Dr. Fendrick invented value-based-insurance-design, or VBID, — which was finally implemented as a Medicare Advantage model by CMS Innovation Center (CMMI) in 2017 (so he must feel like he has to look through a space telescope to see how the system is learning from his long-ago idea). In his recent blog post, Dr. Fendrick endorses the automation of the prior authorization process so it focuses on eliminating harmful and wasteful care and is quick and easy (or just not applied at all) for high-value services. We hope we don’t have to wait for a billion years to learn this lesson — the images will not be as pretty as NASA’s.
July 15, 2022 | 2 min read
July 15, 2022
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