No legacy systems. No inherited workarounds. No spreadsheets held together by institutional memory and a collective agreement to never ask why they still exist.
Just a blank slate, a clear mission, and everything we know now about what healthcare administration actually costs providers.
Most health system leaders never get that question seriously. They spend their careers optimizing around infrastructure built decades ago for problems that no longer exist, inheriting the scar tissue of every previous attempt at modernization. The question feels academic. A luxury for people who do not have 43 prior auth requests sitting in a queue before lunch.
But the question is worth sitting with. Because the answer reveals exactly how far the current reality is from what care delivery should actually look like.
Nobody Would Build This on Purpose
Would you design a system where prior authorizations routinely take seven days? Where physicians need to become insurance experts just to get patients the care they already ordered? Where a nurse with 15 years of clinical experience spends 90 minutes documenting what she already knows?
No rational person would architect that deliberately. And yet here we are. Because no one did build it deliberately. It accumulated. Decision by decision, workaround by workaround, legacy system layered on top of legacy system, until the administrative layer of healthcare became something that manages risk rather than accelerates care.
The Real Cost Nobody Is Measuring Correctly
Every prior authorization sitting in a queue is a patient in pain waiting on paperwork. Every claim that bounces back is a provider burning time on bureaucracy instead of care. Every rework cycle is a physician doing insurance administration instead of medicine.
This is not inefficiency. It is harm. Scaled, systematized, and normalized to the point where the industry has largely accepted it as the cost of doing business. It is not. It is the cost of building systems that were never designed around patient outcomes in the first place.
What Starting From Scratch Actually Requires
A genuine reset demands a few uncomfortable admissions.
Incremental improvement of fundamentally broken processes is just slower failure. Ten percent faster prior auths is ten percent less waiting. Patients are still waiting. The goal cannot be optimization. It has to be elimination of work that should never require human intelligence in the first place.
And the people closest to the problem need the authority to fix it. Operations leaders, clinical informatics teams, revenue cycle directors. They know exactly where the friction lives. They have been building heroic workarounds for years. What they have lacked is the infrastructure to act on that knowledge without a lengthy IT implementation cycle or a vendor contract for a tool that solves half the problem.
One Organization Handing That Authority Back
Penguin Ai’s Gwen was built on exactly this premise. Rather than delivering a predetermined workflow and asking health systems to conform to it, Gwen is a prompt builder that puts creation directly in the hands of the teams who understand the work.
Operations leaders and clinical teams can build their own workflows and digital workers from scratch, designed around the specific realities of their organization. Critically, that freedom operates within the governance, datasets, and regulatory connections that healthcare actually requires. Humans remain in the loop throughout. The art of medicine stays with clinicians. What Gwen removes is the administrative weight surrounding it.
The blank slate question is not academic. For the first time, it is a design brief provider teams can actually act on.
It is time to build what we would have built from the start.
Becker’s 3rd Annual Fall Chief Pharmacy Officer Summit is the top tier event that the people leading the future of pharmacy convene. This 3-day event is built specifically for Chief Pharmacy Officers and senior pharmacy leaders. The sessions examine the workforce, financial and clinical priorities shaping pharmacy today. Becker’s is where candid discussions flourish and new ideas thrive. Becker's 3rd Annual Fall Chief Pharmacy Officer Summit
