\u201cTrust but verify\u201d is a phrase often associated with President Reagan and the need to ensure that treaties enacted with the Soviet Union were being upheld. Today, that wise advice applies equally to commercial health insurers.<\/p>\n
That\u2019s why the AHA is engaged in many efforts to protect patients\u2019 health and ensure that medical professionals, not the insurance industry, are making the key decisions in patient care.<\/p>\n
In late June, the AHA applauded the administration\u2019s role in facilitating a pledge by several major health insurers to reform prior authorization processes through standardization, volume reductions and minimizing care delays and disruptions.<\/p>\n
As adopted, the industry\u2019s retooling plan would apply to patients covered by Medicare Advantage, Medicaid managed care plans, Health Insurance Marketplace plans and commercial plans.<\/p>\n
The AHA has long been advocating for such an overhaul, and it is long overdue. Too often, prior authorization has been used in a manner that leads to dangerous delays in treatment, clinician burnout and waste in the health care system. The burdensome requirements often delay patient access to necessary care or lead to treatment abandonment, putting patients at risk \u2014 especially those with chronic or serious conditions.<\/p>\n
Moreover, prior authorization\u2019s administrative delays and denials add tremendous cost and burden to the health care system, vacuuming up staff time with paperwork and reducing bedside time spent on personal patient interaction. In some cases, hospitals have seen frustration with the system contribute to heightened tensions in clinical settings, placing medical staff at increased risk of workplace violence. These imposed obstacles to optimal patient care can also lead to burnout and exacerbate the already serious workforce shortage by diminishing the joy in the purposeful work of caring \u2014 the very thing that draws so many gifted providers to health care in the first place.<\/p>\n
For these reasons, it is vitally important that commercial health insurers are held accountable to meet the letter and spirit of their pledge and \u201cwalk the walk\u201d of prior authorization reform.<\/p>\n
This week, AHA provided recommendations<\/a> to the Department of Health and Human Services and the Centers for Medicare & Medicaid Services to help ensure that commercial insurance plans are living up to their promise and easing the burden of the complex and time-consuming prior authorization process on patients and providers.<\/p>\n Suggestions include monitoring plans\u2019 progress in fully implementing existing regulations<\/a> such as the interoperability and prior authorization final rule and\u00a0reforms issued in the 2024 Medicare Advantage final rule.<\/p>\n Meanwhile, the AHA continues to urge Congress to pass the Improving Seniors\u2019 Timely Access to Care Act of 2025<\/a> (H.R. 3514\/S. 1816), bipartisan legislation with widespread support in Congress. The bill would streamline the prior authorization process in the Medicare Advantage program by eliminating complexity and promoting uniformity to reduce the wide variation in prior authorization methods that frustrate both patients and providers.<\/p>\n