Assessing Opportunities in the Prior Authorization Market

The Challenge

Prior authorization (PA) is costing the healthcare industry $23 – 31 billion dollars annually, not inclusive of the cost of frustrations felt by both providers and health plans in the act of processing PA requests. A national consortium of health plans engaged crankfrog to better understand the underlying challenges caused by PA processes for providers and health plans. Specifically, the consortium wanted to understand if the issue proved viable enough for investment and aligned with the organization’s strategic vision.

Our Approach

crankfrog conducted detailed interviews with major national health plans and notable provider groups, and performed market research to identify key pain points and challenges surrounding the current state of PA processes. Based on these findings, we convened and facilitated an industry-level workgroup of health plan representatives on behalf of the consortium to secure consensus opinion of industry challenges and design various solution opportunities.

Results

crankfrog presented a comprehensive overview of current state challenges with prior authorizations to the consortium’s Board of Directors. The PA market proved to be ripe with possibility, but did not represent an opportunity that directly aligned with the organization’s strategic vision. The discovery materials have since been absorbed into the organization’s knowledge base for industry reference.