AI And Standards Aren’t Enough: Fixing Prior Authorization Will Require Something Else Entirely

At Premier, one of the country’s largest group purchasing organizations representing more than 4,400 hospitals and health systems, addressing the burden of prior authorization is a priority. The company in 2018 acquired Stanson Health, a technology company providing clinical decision support tools that are integrated into providers’ EHR systems. As Stanson Health’s Ryan Nellis explains, “Prior authorization is clinical decision support. It’s a set of rules, based on evidence. It’s just frustrating because it happens after the fact, and makes everybody [providers and patients] wait until it’s resolved.”

Nellis touts the company’s novel approach, in which it ingests prior authorization rules from partnered health plans and applies those rules within a provider’s EHR workflow, as a key reason the company has seen its technology deployed to more than 1,000 hospitals.

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