Jesse M. Ehrenfeld, MD, MPH President | Official website
UnitedHealth Group's recent commitment to streamline its prior authorization process has been met with cautious optimism by the American Medical Association (AMA). The AMA has highlighted the need for more specific and impactful changes to alleviate what it describes as a burdensome system.
According to a statement from the AMA, "It’s good news that UnitedHealth Group is finally looking for ways to simplify and accelerate their prior authorization process. But seven years after a consensus statement in which the insurance industry agreed to key reforms to improve this onerous process—and with the burden and outcomes only worsening—patients, physicians and policymakers are looking for specifics and meaningful, impactful changes that will break down unnecessary roadblocks and keep medical decisions between patients and physicians."
The AMA emphasized several actions necessary for improvement: reducing the volume of requirements, employing transparent clinical criteria based on evidence, ensuring qualified physicians handle denials, and making timely decisions. They stated these reforms should apply across all markets, including self-funded plans. The organization pointed out that surveys indicate prior authorization barriers have led to life-threatening situations for patients and contribute significantly to physician burnout.
"Improving the prior authorization process requires meaningful actions like significantly reducing the volume of requirements, using transparent and evidenced-based clinical criteria, ensuring that qualified physicians are the only ones making denials, and requiring that decisions are made within hours, not days or weeks," said the AMA. "Moreover, these reforms must be made across all markets, including self-funded plans, and laws must be adhered to when they are in place."
The AMA also called for immediate action beyond mere discussions about progress. "While talking about forward progress on this issue is a positive step," they noted, "it must be followed by substantive actions. A new year demands a new approach—enough with promises that nibble around the edges of the problem and benefit few if any."
The organization concluded by urging health insurers to commit fully to reforming prior authorization processes: "Our patients deserve broad and meaningful prior authorization reforms, and we urge health insurers to get on board with immediate actions."
