Tackling Prior Auth: New Solutions to Address Provider-Payer Friction

Prior authorization (PA) solutions are on the cusp of a breakout moment, partially driven by both the growing adoption of value-based care (VBC) arrangements, as well as sophistication of new enabling technologies, including APIs, NLP, and AI. A new PA model is emerging that promises to deliver mutually beneficial results for providers and payers with far less pain, better integrating CDS, claims, and order workflows at the point of care.

With the dubious honor of being one of the thorniest pain points in provider-payer collaboration, and sitting at the start of the revenue cycle, PA is a logical starting point to establish greater provider-payer convergence. Chilmark Research projects that this new evolution in PA technology will serve as a petri dish for greater forms of convergence that will then spread to other VBC strategies.

To learn more, watch analyst Jennifer Roger's webinar that accompanied the release of this report:



This report answers the following questions:

  • How is PA evolving for providers and payers alike, given the growing expansion of VBC adoption?
  • What is the current state of pharmacy and medical PA technology and process?
  • Who is innovating in this space to improve the provider-payer experience and clinical and cost outcomes?
  • What should healthcare organizations (HCOs) consider as they decide on a solution?
  • Where do significant gaps remain that HCOs will struggle to fill?


Vendors Profiled: AccentureathenahealthAvailityChange HealthcareCognizantCoverMyMedseviCoreMCGPartners HealthcareSurescriptsZipRad

Number of Pages: 44

Published: July 2017

Cost: FREE

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