Health insurers covering more than 250 million Americans have unveiled a sweeping plan to streamline and reduce prior authorization requirements — a long-standing source of frustration and burnout for providers and patients. The voluntary reforms, hailed as a modernization effort by payers, aim to accelerate approvals, simplify processes and reduce administrative burdens across commercial, Medicare Advantage and managed Medicaid plans.
But many hospital leaders argue they’ve heard promises like this before.
While providers welcome the prospect of meaningful change, they are watching closely — and some remain skeptical that these reforms will deliver the sustained, measurable relief the system urgently needs.
Health system CEOs describe the initiative as “a step in the right direction” but warn that without accountability, the effort could simply accelerate denials or shift administrative hurdles elsewhere in the revenue cycle.
Nine health system leaders shared their perspectives with Becker’s on the proposed changes and whether they believe this time will bring meaningful change.
Editor’s note: Responses were lightly edited for length and clarity.
Question: Do you believe these reforms will meaningfully ease the strain on your clinicians, patients and health system?
Chris Van Gorder, President and CEO, Scripps Health (San Diego): I think it’s a step in the right direction and any improvement in speed will be beneficial for patients, clinicians and health systems but it’s a very minor improvement which is long overdue. I don’t believe that it will substantially decrease denials but might just speed up the denial process.
Cliff Megerian, MD, CEO, University Hospitals (Cleveland): Yes — if the number of services requiring prior authorization is truly reduced. For example, at University Hospitals, we handle approximately 165,000 prior authorization cases each year for advanced imaging (CT and MRI). While many are initially denied, less than 1% are ultimately declined after peer reviews and appeals — meaning the process often delays care with little added value. It’s a major driver of burnout for our physicians and staff. Standardization will also make a real difference. Today, our teams navigate multiple portals, each with its own criteria and data requirements. A streamlined, consistent process would save time and reduce administrative waste. We’re already moving in this direction. Our rollout of Rhyme prior authorization, which integrates with Epic, has automated medical necessity checks and reduced manual steps — especially in radiology and cardiology, where the burden is high. The early results show better throughput and less friction for staff and patients.
Jochen Reiser, MD, PhD, President, The University of Texas Medical Branch; CEO, UTMB Health System: The intent behind these reforms is positive, and we would like to believe they will lead to a reduction in burden. However, to date, the program hasn’t played out that way in practice. In Texas, only about 3% of clinicians received approval for a six-month period. The program is also very specific to certain procedures and difficult for providers to track, often making it simpler to just follow the existing prior authorization process.
Carol Gomes, MS, CEO and COO, Stony Brook (N.Y.) University Hospital: The move to reduce prior authorization may result in a more seamless patient experience and providers can focus on their unwavering commitment to patient care. It’s critical to support national-level actions to provide patients with medically necessary covered services, as well as improvements to administrative efficiency to ensure safe, effective care is delivered in a timely and cost-effective manner.
Trampas Hutches, President, MaineHealth Mountain Region (Portland, Maine): There’s real promise in these reforms — and a real opportunity, if done right. Prior authorization has long been a source of burnout for our physicians and advanced practice professionals. It drains time, erodes morale and delays care. While digital tools help, the arms race between payer requirements and provider workarounds has only added cost and complexity to the system.
What’s exciting about this moment is the chance to reallocate that energy — to shift from chasing approvals to redesigning how we deliver care. If these changes truly reduce friction, our teams can spend more time with patients and less time navigating bureaucracy. That’s where innovation happens, and where trust starts to rebuild.
David Rahija, PT, President, Endeavor Health Northwest Community Hospital (Arlington Heights, Ill.): Anything that reduces unnecessary administrative burdens would be a positive development. This would allow our clinicians to spend more time providing direct care to patients, and allow our patients to focus on their health and wellbeing instead of insurance coverage.
Barry Arbuckle, PhD, President and CEO, MemorialCare Health System (Fountain Valley, Calif.): Certainly changes need to be made, but we will need to be diligent to avoid/reduce unintended consequences. Overall, prior authorization standardization and automation is a good thing, especially around auto-approvals. The intent of the reform is logical and should benefit patients and providers, but the transition and regulatory oversight of that transition will add temporary burden as providers navigate how to interpret/implement all the requirements and report out to our various payers that we are meeting such requirements.
Moving away from denials and auth gatekeeping further shifts the focus to provider performance management. That means managing cost of care and outcomes must happen at the point of care and through proactive population health programs and not downstream via [utilization management] workflows. Some/many providers either have limited experience or limited infrastructure/staff to accomplish this.
Reduction in guardrails to prevent unnecessary utilization has the potential to drive up the cost of healthcare. Moreover, it risks reducing specialty access secondary to unnecessary utilization filling up schedules.
I am not sure primary care physicians will have the same incentive to tightly manage their patients, if there are no prior auth requirements. This will also drive up outside medical expense.
Network steering is critical in our value-based care designs and narrow network products where the individual/employer was given a reduced rate/cost with the expectation that they would remain in-network. Providers in these sorts of products provide appropriate clinical care, at the right time to the right specialist in the appropriate settings, i..e., imaging at the hospital vs. freestanding, different pricing for the same service or sending a patient to a specialist that doesn’t treat various conditions.
From reports, we understand that Individual health plans will commit to specific reductions to prior authorizations, with reductions rolling out by Jan. 1, 2026. Whenever we see quotas for things like this, we start seeing gaming to meet quotas. That has been true recently it seems from what one very large PBM is doing by cancelling our RX prior authorizations versus. denying and causing delays and confusions. This has been newly happening since February —- the wording seems to have changed to cancellations at the same time they promised to reduce denial numbers to their shareholders.
Merry-Ann Keane, MSN, superintendent and CEO, Ocean Beach Health (Ilwaco, Wash.): I look forward to seeing both public and private reforms fully implemented and unnecessary red tape finally reined in. Ocean Beach Health is a small, rural public hospital district, and 80% of our patients are covered by Medicare or Medicaid. In communities like ours, where staffing is lean and access to care can already be limited, administrative delays have an outsized impact. Streamlining prior authorization is one step toward making care more accessible, responsive and sustainable for the communities we serve.
I am hopeful that the CMS Interoperability and Prior Authorization Final Rule, along with voluntary reforms by private insurers, will lead to more timely, efficient care and reduce the burden on our providers and their support staff. While Ocean Beach Health sees fewer patients with private health insurance, the anticipated changes should allow our providers to focus on what truly matters — patient care — and less time chasing approvals.
Prior authorizations, coupled with state charity care laws, are marginalizing small rural critical access hospitals. Regulatory loops demand uncompensated care for vulnerable, rural populations while placing rural healthcare access at risk. I hope that the changes proposed will enable hospitals to be fairly compensated for care provided, easing the financial strain placed on our public hospital district.
Q: Are you confident these commitments will be implemented and sustained?
Chris Van Gorder, President and CEO, Scripps Health (San Diego): Denials are a key mechanism to increase insurance company profits. Yes, it can be used to control unnecessary tests and control the increase in health costs but I’m not convinced that this will significantly reduce denials or the percentage of denials that are overturned on appeal which is an indicator of abuse. This voluntary plan appears to me to be an effort to delay state and federal legislation that would mandate this type of effort and more — with penalties. There is no penalty, audit or true accountability in a voluntary effort.
Jochen Reiser, MD, PhD, President, The University of Texas Medical Branch; CEO, UTMB Health System: We are optimistic about the future of initiatives aimed at reducing burdens for providers. The success truly lies in the details of these programs. We are keen to collaboratively work through challenges to ensure that we all benefit in the long term. We value the opportunity to discuss these important topics and look forward to continued collaboration with all payers and regulatory agencies.
Cliff Megerian, MD, CEO, University Hospitals (Cleveland): We’re optimistic. There’s broad recognition — even among payers and their trade associations — that the current prior authorization process can and should be improved. If the industry follows through on reducing volume and standardizing processes, we believe these changes will be lasting. Continued leadership from CMS and other regulatory agencies will also play an important role. Their ongoing efforts to advance prior authorization reform and monitor compliance will help ensure that progress is sustained so that patients and providers alike benefit from a more streamlined, predictable process.
Shawn McCoy, CEO, Deaconess Health System (Evansville, Ind.): I remain skeptical but I hope to be proven wrong. This issue has been debated at both the federal and state level with legislation enacted to combat prior authorizations, yet little impact has been felt by providers and patients. While I believe in some controls to reduce fraud and abuse, some payers have taken prior authorizations and denial of care to the extreme as a tool to improve their probability. If progress is made on prior authorization we have to ensure payment denials are not just shifted to another point in the revenue cycle. This sort of bait and switch will just cause even further administrative burden in a system that is far beyond the breaking point.
Trampas Hutches, President, MaineHealth Mountain Region (Portland, Maine): We’ve heard similar commitments before, and progress has been uneven. But I’m optimistic. This time, there’s more urgency and alignment between federal policy and payer promises. The healthcare system is at an inflection point — and I believe there’s a shared recognition that we can’t keep piling administrative layers on top of exhausted care teams and confused patients.
Success will depend on transparency, follow-through, and a willingness to measure what matters — not just process changes, but outcomes for patients and clinicians. If we get that right, this isn’t just about cutting red tape. It’s about reclaiming time and trust — and using both to build something better.
Carol Gomes, MS, CEO and COO, Stony Brook (N.Y.) University Hospital: More than 50 health insurers, including major companies, have made voluntary commitments to address concerns about prior authorization. I would like to see the list continue to grow. This is a bold step toward meaningful progress. We invite health plan executives to collaborate with us in identifying and addressing the most common provider authorization barriers.
David Rahija, PT, President, Endeavor Health Northwest Community Hospital (Arlington Heights, Ill.): We will need to understand the details. This would be a major change to the insurance company business model. We will need to see how insurers implement this change and if it will be replaced by new tactics or administrative burdens that could also delay care for our patients.
Merry-Ann Keane, MSN, Superintendent and CEO, Ocean Beach Health (Ilwaco, Wash.): Prior authorizations, in theory, prevent unnecessary treatments, tests and hospitalizations; in reality, they have become barriers to necessary healthcare. Denying necessary care, at the expense of patient and provider health, increases margins for insurance companies, which makes meaningful change difficult to implement. Unless preauthorization change is made with meaningful results, both patients and health systems will continue to struggle. Only time will tell if the reforms will be meaningful.
