Gartner Research

Healthcare Collaboration Point for CIOs: Prior Authorizations

Published: 04 June 2019

ID: G00388214

Analyst(s): Bryan Cole , Jeff Cribbs , Mandi Bishop

Summary

The IT systems and business processes that support prior authorizations cause inefficiency, waste and delays — frustrating payers, providers and consumers alike. Use this research to make providers’ prior authorization submissions and payers’ medical policy reviews seamless in real time.

Table Of Contents

Analysis

  • Prior Authorization Processes Put Consumers in the Middle of Payers’ and Providers’ Struggle to Lower Healthcare Costs
    • Both Payers and Providers Are Talking About a Better Way
    • Inefficient Prior Authorization Processes Persist, Rankling Payers and Providers
  • Make Prior Authorizations Efficient and Value-Adding for Consumers
  • Future Vision for Payers and Providers: Real-Time, Personalized Medical Policies and Interventions Meet Each Consumer’s Unique Needs
  • Recommendations
    • Achieve the Vision: Near- and Intermediate-Term Recommendations for Payer and Provider CIOs
    • Provider CIOs
    • Payer CIOs

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