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Health care industry

Health Insurers Commit to Simplifying Pre-Treatment Reviews Amid Growing Concerns

Strategic Insights

— 1 min read

More than 50 health insurers, including UnitedHealthcare, Aetna, CVS Health, Cigna, and Kaiser Permanente, have pledged to simplify pre-treatment reviews, a practice widely despised by healthcare providers and patients. The commitment aims to address issues with prior authorization requirements, which have led to patient abandonment of treatment and physician burnout. According to an American Medical Association survey, nearly 90% of physicians cited prior authorizations as a contributor to burnout. The insurers will work to create common electronic prior authorization submission requirements and honor prior pre-treatment approvals when patients change plans during treatment.

Key Takeaways:

  • Over 50 health insurers, including major players like UnitedHealthcare and CVS Health, have committed to simplifying pre-treatment reviews by 2027.
  • Insurers aim to answer at least 80% of electronic prior authorization requests in real-time with necessary clinical documentation by 2027.
  • The commitments cover all insurance markets, including private health plans and Medicare Advantage, and are led by AHIP and the Blue Cross Blue Shield Association.
  • UnitedHealthcare, Aetna, CVS Health, Cigna, Elevance, and Kaiser Permanente have pledged to reduce claims subject to prior authorization "as appropriate for the local market" by the start of next year.
  • Insurers will honor prior pre-treatment approvals when patients change plans during a 90-day transition period.
  • The American Academy of Family Physicians has expressed measured approval of the initiative, stating that real changes in patient and physician experiences will ultimately measure its impact.
  • Prior authorization concerns have persisted despite a 2018 consensus statement from major trade associations and the Biden administration's rules to streamline requests.
  • Several insurers have announced plans to scale back their prior authorization requirements in recent years.

Statistics:

  • 8 in 10 physicians (AMA survey, 2023) believe that issues with prior authorization requirements led patients to abandon treatment.
  • 90% of physicians (AMA survey, 2023) cited prior authorizations as a contributor to burnout.
  • By 2027, insurers aim to answer at least 80% of electronic prior authorization requests in real-time with necessary clinical documentation.
  • Insurers will work to create common electronic prior authorization submission requirements by January 1, 2027.

Sources:

  • American Association of Health Plans (AHIP). News release. (2024, March 1)
  • Axios. "Why health insurers are simplifying pre-treatment reviews." (2024, March 1)
  • American Medical Association. "Prior Authorization Survey." (2023)
  • Axios. "Health insurers commit to simplifying prior authorization." (2024, March 1)
  • American Academy of Family Physicians. Statement on health insurers' commitment to simplifying pre-treatment reviews. (2024, March 1)
  • AHIP. "Prior Authorization Consensus Statement." (2018)

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