Prior Authorization: It's Me, Hi, I'm the Problem, It's Me

When it comes to prior authorization, healthcare organizations are often their worst enemy. Health systems and PBMs are mired in a process that creates more friction than flow, with administrative requirements that complicate rather than improve patient care. With denial rates for Medicare Advantage claims surging nearly 56% between 2022 and 2023, the current system is unsustainable. Emerging technologies like generative AI offer a promising path forward, potentially transforming an antiquated process that has resisted meaningful change for years. The value of streamlining prior authorization is clear: improved care delivery, reduced administrative burden, and more efficient healthcare interactions. By adopting an approach that prioritizes patient needs and leverages technological innovation, we can break through the prior auth bottleneck. It’s time for prior authorization to take a good, hard look in the mirror!