Ninety-three percent of health plan executives anticipate AI will contribute value by automating prior authorizations, according to an analysis of Deloitte survey results released Jan. 15.
The Deloitte Center for Health Solutions surveyed more than 100 C-suite leaders across healthcare, including health insurance executives, during August and September. Deloitte Consulting Senior Manager Mike Selvage and Managing Director Albert Yu broke down specific findings on prior authorization.
CMS lowered the standard turnaround time for prior authorization decisions to seven days effective Jan. 1, affecting Medicare Advantage, Medicaid and ACA plans. The consultants argued that AI can alleviate this burden.
Here are five takeaways from the analysis:
1. Provider use of AI through EHRs can translate to more robust patient data collection but poses a challenge for payers dealing with an influx of information amid regulatory changes. The report described prior authorization policies as “increasingly nuanced.”
2. Instead of assigning more clinical staff to review records, payer AI adoption can effectively mine records and validate clinical criteria, with staff oversight.
3. Large, national carriers have more interest in AI investment than their smaller, regional counterparts.
4. Vendors have opportunities to share scaled off-the-shelf AI solutions that span prior authorizations across all service categories.
5. Ninety-seven percent of the 58 health plan executives surveyed said agentic and generative AI can add value to clinical and care enablement work, specifically with prior authorization, patient engagement and claims processing.
