06 Sep Principles for Prior Authorization Policies in Value-Based Care Arrangements

The Health Care Transformation Task Force developed Principles for Prior Authorization Policies in Value-Based Care Arrangements to improve the prior authorization process for payers and providers as they implement and refine value-based care arrangements. Current prior authorization policies impose significant burdens on patients, providers, and payers, often leading to delayed or denied care for patients. The Task Force believes that value-based care arrangements have the potential to reduce the need for prior authorization and streamline the process to focus on promoting patient safety, incentivizing guideline-adherent care, and reducing low or no value items or services. 

The purpose of the resource is to: (1) promote the delivery of guideline-adherent care, (2) serve as a guardrail for patient safety, (3) minimize delays in care and patient burden, and (4) reduce administrative costs and friction between payers and providers. 

The principles center on the premise that prior authorization policies should be:  

1. Collaborative: Prior authorization policies should be developed in collaboration with providers and adjusted to account for shifting provider incentives under value-based care arrangements.  
2. Safe: Prior authorization standards should prioritize patient safety and the promotion of high-quality care.  
3. Transparent: The prior authorization process should be transparent for patients, purchasers, and providers.      
4. Efficient and Patient-Centered: The prior authorization process should be efficient, minimizing the burden on patients, providers, and payers, and should prioritize continuity of care for patients.      
5. Expedient: The prior authorization process should minimize delays in care for patients. 

View the Resource

View the Principles, Drivers, and Actions in table format here