Health insurers covering more than 250 million Americans recently unveiled a sweeping plan to streamline and reduce prior authorization requirements — a pledge met with cautious optimism by revenue cycle leaders, who are waiting to see whether the promises will bring real-world change.
Five health system revenue cycle executives shared their thoughts with Becker’s on the payers’ pledge:
Editor’s note: Responses were lightly edited for length and clarity.
Chad Bills. Vice President of Revenue Cycle at Community Health Network (Indianapolis): I remain cautiously optimistic about this development. The introduction of electronic submission standards is undoubtedly a step in the right direction. It holds the promise of reducing both costs and delays in patient care, which is a significant win for our patients and our healthcare system.
There is still room for improvement. One critical aspect that I believe needs more attention is ensuring that authorization is a guarantee of payment. This would provide much-needed certainty and stability for healthcare providers, allowing us to focus more on delivering quality care rather than navigating administrative hurdles.
I look forward to seeing how these reforms will unfold and impact our industry.
Robert Boos. Vice President of Revenue Cycle at Centra Health (Lynchburg, Va.): It’s encouraging to see major payers publicly acknowledge the burden that prior authorization places on patients and providers. Any movement toward reducing unnecessary delays and administrative overhead is welcome. However, the real impact will depend on the implementation details. We’ve seen similar pledges in the past that didn’t lead to meaningful change at the front lines of care delivery.
If these reforms result in more automated approvals for routine services, greater transparency in criteria, and fewer retroactive denials, then yes, they could help reduce strain on health systems. Until then, we remain cautiously optimistic and will be watching closely to see if the operational reality matches the announcement.
Carrie Donovan. Chief Revenue Officer at Advocate Health (Charlotte, N.C.): It is difficult to anticipate the impact of the planned changes until we experience them. In addition to reducing the costs of administrative burden, it is most beneficial to patients who will be able to access the care they need in a more timely manner.
Benjie Johnson. Chief Revenue Officer at Michigan Medicine (Ann Arbor): It’s certainly positive that insurers are pledging to ease prior authorization requirements. Given the fact that we have only seen prior authorizations increase over the years, it will take a significant effort on their part to make a meaningful change to ensure that patients receive needed care timely and that providers are not burdened with these administrative tasks.
Marji Karlin. Chief Revenue Officer at NYC Health + Hospitals (New York City): If these reforms are adopted uniformly, there will be an impact on providers. Health systems devote significant staff and financial resources to managing the prior authorization process. Reducing the volume of services that require authorizations — and finally adopting standardized, automated transactions — will allow health systems to redeploy staff to higher-impact areas, ultimately improving both efficiency and patient care.
