Prior authorization volumes are climbing and payer policies shift mid-year. Denial rates continue to rise across the industry. In that environment, the pull for revenue cycle teams is to pursue every new problem, respond to every escalation, chase every trend. Mike Vigo, chief revenue cycle officer at University of California San Diego Health in San Diego, wants his team to resist it.
“Every time our leadership team aligns with some of our nonnegotiables, and one of those is we try to self correct ourselves when we start going down maybe some rabbit holes or some soap boxes where we’re talking about things that start to go into areas that are uncontrollable,” Mr. Vigo said. “They’re outside of our control.”
The distinction — between what a revenue cycle team can affect and what it cannot — shapes how Mr. Vigo structures priorities, manages the physician relationship and protects his staff from the cycle of working problems that have no internal solution. The approach has a track record at UC San Diego Health. In fiscal 2026, which closed June 30, the revenue cycle team achieved significant reductions in what Mr. Vigo described as controllable loss, including a dramatic decline in fatal denials, built on operational workflows designed to sustain those gains rather than produce one-time results.
Prior authorization is where the framework faces its toughest test. At UC San Diego Health, a large academic medical center serving patients across a nearly complete range of specialties, authorization burden is a persistent friction point between revenue cycle and clinical teams. Prior authorization automation has ranked among the top revenue cycle initiatives leaders are prioritizing in the second half of 2026. Mr. Vigo said his team’s investment and attention go toward what they can actually influence.
“We’re doing our absolute best to reduce the peer-to-peers that are being asked to them, to use technology and automation, to work with our contracting team, to get that messaging and work our contract language to be less invasive with the physicians,” he said.
The counterpart is equally explicit. “What we cannot control is the ultimate decision by some of those insurance firms and the criticality or acuity that might be coming in the door and how the contract’s being based or why that provider is being reached out to,” Mr. Vigo said.
Rather than allowing prior authorization friction to become an ongoing grievance where revenue cycle teams absorb responsibility for decisions made by payers, the approach at UC San Diego Health is to be clear with physicians about both what the team is actively doing and what falls beyond its reach.
“Educating our doctors clearly and saying, physicians, this is what we can do. This is what we are doing. We take your concerns very seriously. Here’s our plan of attack. We’d love your input,” he said. “But at the same time, here are some items that we cannot control.”
The same clarity extends inward. Revenue cycle departments operate as service organizations, and the scope of that service matters for how staff sustain engagement when external pressures are high.
“I think that they would love to solve all the problems. We truly do. We’re a support service. We know that,” Mr. Vigo said. “But at the end of the day, we really need to focus on what we can control.”
Maintaining that internal focus on clean workflows, strong data discipline and sustainable performance management across patient access, coding and billing also sets the terms for how the department approaches technology decisions. Mr. Vigo has been consistent on the sequencing: automation and AI deployed on top of weak processes produce weak results. Getting the controllable layer right comes first.
As payer pressure and prior authorization have continued to top the list of priorities revenue cycle leaders are working to address in 2026, Mr. Vigo’s framework offers a specific answer to a broader challenge: how to keep teams performing well when the hardest problems are not theirs to solve.
