HHS promotes insurer pledge to scale back prior authorization
Federal health officials on Monday touted pledges they have received from the health insurance industry to streamline and reform the prior authorization process for Medicare Advantage, Medicaid Managed Care and Affordable Care Act Health Insurance Marketplace plans which account for most insured Americans.
Health and Human Services (HHS) Secretary Robert F. Kennedy Jr. and Centers for Medicare & Medicaid Services Administrator Mehmet Oz took part in a roundtable discussion with insurers in which the payers pledged commitments to six key reforms to the prior authorization process.
Health care providers must obtain approval from an insurer before a specific service is covered, and they've criticized that process for being time-consuming and a drag on providing health care.
According to Oz, the roundtable included the CEOs of health insurance companies who cover about 75 percent of Americans. The CMS administrator said he would like fewer services to be subject to preauthorization.
Medicare Director Chris Klomp gave the example of colonoscopies or cataract surgeries as procedures that could be moved out of the prior authorization process.
Referencing the biblical passage that reads 'the meek will inherit the earth,' Oz said in a press briefing that health insurance companies and hospital systems have 'agreed to sheath their swords, to be meek for a while.'
Major health insurers including Cigna, UnitedHealthcare and Aetna said they would be simplifying the process and reducing the number of health care claims subject to prior authorization.
The voluntary commitments include standardizing the electronic prior authorization process; reducing the number of claims subject to prior authorization; ensuring continuity of care when patients change plans; enhancing communication and transparency when it comes to determinations; increasing the numbers of real time responses; and ensuring medical review of denied requests.
By cutting down on red tape, Oz said 'tens of billions of dollars of administrative waste' could be saved.
Kennedy acknowledged that similar commitments have been made by the health insurance industry in the past, but said this instance was different because of the number of insurers who have signed on to the voluntary agreement.
'The other difference is we have standards this time. We have, we have deliverables. We have specificity on those deliverables, we have metrics, and we have deadlines, and we have oversight,' said Kennedy.
Oz suggested another difference was a change in Americans' current consensus on prior authorization compared to the past.
'I mean, there's violence in the streets over these issues. This is not something that is a passively accepted reality anymore. Americans are upset about it,' said Oz. 'I think the major factor is the industry realizes that some of the things that are preauthorized just don't make any sense.'
'The health care system remains fragmented and burdened by outdated manual processes, resulting in frustration for patients and providers alike. Health plans are making voluntary commitments to deliver a more seamless patient experience and enable providers to focus on patient care, while also helping to modernize the system,' said Mike Tuffin, president and CEO of the health insurance trade association AHIP.
According to a 2024 survey by the American Medical Association, 91 percent of physicians said the prior authorization process can lead to negative clinical outcomes and 82 percent said it could lead to patients abandoning their course of treatment.
Acknowledging the voluntary nature of the commitments, Oz said, 'If the insurance industry cannot address the needs of preauthorization by themselves, there are government opportunities to get involved. They might not be as nimble, but they will be used if we're forced to use them.'
Actor Eric Dane, who recently disclosed his diagnosis of amyotrophic lateral sclerosis (ALS), appeared at the press conference to put his support behind the move. Dane famously played a physician on the show 'Grey's Anatomy.'
'I'm here today to speak briefly as a patient battling ALS, also known as Lou Gehrig's disease. When that diagnosis hits and you find out that you're sick, your life becomes filled with great uncertainty,' said Dane. 'The worst thing that we can do is add even more uncertainty for patients and their loved ones with unnecessary prior authorization.'
Sen. Roger Marshall (R-Kan.) and Rep. Greg Murphy (R-N.C.) joined Kennedy and Oz at HHS headquarters. Both lawmakers have previously introduced legislation seeking to reform and streamline the prior authorization process under Medicare.
Marshall and Murphy, both physicians, touched on how the prior authorization process has negatively impacted their patients.
'I vividly remember a patient I once had scheduled for an infertility surgery. She'd taken time off work and arranged help at home, only to be told the morning of a procedure that her insurance company had added another step to the prior authorization process, abruptly canceling her surgery,' Marshall recounted. 'Now, whether you need a hip replacement or a heart catheterization, many patients feel their critical care has been delayed by an opaque and burdensome prior authorization process.'
The senator from Kansas said he was still committed to codifying preauthorization reforms despite the commitments made Monday.
Describing himself as a 'skeptic,' Murphy said he would be keeping an eye on insurers to make sure they're 'doing what they're saying they're going to do.' He touched on the role of artificial intelligence in today's prior authorization process.
'Artificial intelligence should help this tremendously, tremendously, and it should take out a lot of the variances that happen between doctors, hospitals, regions of the country, etc. But remember, artificial intelligence only is as good as what you put into it,' said Murphy.
Physicians have previously expressed concerns about the role of artificial intelligence in the preauthorization process, with some evidence suggesting AI-use results in higher rates of denials.
In March, Murphy joined with bipartisan House colleagues in reintroducing the Reducing Medically Unnecessary Delays in Care Act. Among other measures, the bill would bar Medicare administrative contractors from denying coverage of health care services solely because it does not meet an evidence-based standard and would require input from practicing physicians prior to establishing clinical criteria for preauthorization review.
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'They told my parents I would never walk or move again.' It was 1959, and Duguay, of Clearwater, Fla., had polio. It mostly preyed on children and was one of the most feared diseases in the U.S., experts say, causing some terrified parents to keep children inside and avoid crowds during epidemics. Given polio's visibility, the vaccine against it was widely and enthusiastically welcomed. But the early vaccine that Duguay got was only about 80% to 90% effective. Not enough people were vaccinated or protected yet to stop the virus from spreading. Duguay initially defied her doctors. After intensive treatment and physical therapy, she walked and even ran — albeit with a limp. She got married, raised a son and worked as a medical transcriptionist. But in her early 40s, she noticed she couldn't walk as far as she used to. A doctor confirmed she was in the early stages of post-polio syndrome, a neuromuscular disorder that worsens over time. One morning, she tried to stand up and couldn't move her left leg. After two weeks in a rehab facility, she started painting to stay busy. Eventually, she joined arts organizations and began showing and selling her work. Art 'gives me a sense of purpose,' she said. These days, she can't hold up her arms long enough to create big oil paintings at an easel. So she pulls her wheelchair up to an electric desk to paint on smaller surfaces such as stones and petrified wood. The disease that changed her life twice is no longer a widespread problem in the country. So many children get the vaccine — which is far more effective than earlier versions — that it doesn't just protect individuals but it prevents occasional cases that arrive in the U.S. from spreading further. 'Herd immunity' keeps everyone safe by preventing outbreaks that can sicken the vulnerable. But after three decades of eradication, the U.S. has seen isolated polio outbreaks in recent years, typically in communities with low vaccination rates. Every night, Katie Van Tornhout rubs a plaster cast of a tiny foot, a vestige of the daughter she lost to whooping cough at just 37 days old. Callie Grace was born on Christmas Eve 2009 after Van Tornhout and her husband tried five years for a baby. She arrived six weeks early but healthy. 'She loved to have her feet rubbed,' said the 40-year-old Lakeville, Ind., mother. 'She was this perfect baby.' When Callie turned a month old, she began to cough, prompting a visit to the doctor, who didn't suspect anything serious. By the next night, Callie was doing worse. They went back. In the waiting room, she became blue and limp in Van Tornhout's arms. The medical team whisked her away and beat lightly on her back. She took a deep breath and giggled. Though the giggle was reassuring, the Van Tornhouts went to the ER, where Callie's skin turned blue again. For a while, medical treatment helped. But at one point she started squirming, and medical staff frantically tried to save her. 'Within minutes,' Van Tornhout said, 'she was gone.' Van Tornhout recalled sitting with her husband and their lifeless baby for four hours, 'just talking to her, thinking about what could have been.' Callie's viewing was held on her original due date — the same day the Centers for Disease Control and Prevention called to confirm she had pertussis, or whooping cough. She was too young for the Tdap vaccine against it and was exposed to someone who hadn't gotten their booster shot. Today, next to the cast of Callie's foot is an urn with her ashes and a glass curio cabinet filled with mementos including baby shoes. 'My kids to this day will still look up and say, 'Hey, Callie, how are you?'' said Van Tornhout, who has four children and a stepson. 'She's part of all of us every day.' Van Tornhout now advocates for childhood immunization through the nonprofit Vaccinate Your Family. She also shares her story with people she meets, including a pregnant customer who came into the restaurant her family ran saying she didn't want to immunize her baby. She later returned with her vaccinated 4-month-old. 'It's up to us as adults to protect our children — like, that's what a parent's job is,' Van Tornhout said. 'I watched my daughter die from something that was preventable.… You don't want to walk in my shoes.' Ungar writes for the Associated Press.
