Prior authorization

…The end to a prior authorization.…

…Make it similar to the cash price, right? No prior authorization.…

…Based on that rhetoric alone, you'd be forgiven if you assume that health plans everywhere have AI agents that are managing their prior authorizations and reviewing claims and that those AI agents are deep in a battle of the bots with health systems who are also using AI in their case to maximize their approval rates and overturn every denial.…

…And the process that we focused on first was prior authorization, when prior authorization.…

…I was leading our what's now called Carillon business and so I did a lot around payment integrity and prior authorization, which was really really helpful to kind of understand how payers interact with the ecosystem.…

…For example, filling out prior authorization that seems so uh not aligned with the reason why uh most of us went into medical school.…

…It's really easy in conversations about AI to get critical really fast and forget how flawed human only Processes have been, and there is, uh, it's hard to find a place where that is more true than prior authorization or prior auth.…

…Then we have, uh, private insurance plans, some of which have very expansive networks and some of which have very narrow networks and increasing use of prior authorization and other tools for utilization management.…

…But that's when you run into prior authorization, that's when you run into uh, the mechanisms with which these entities keep each other in check, creating tension.…

…So there was actually a state law passed that was unanimously passed, uh, to do reform of prior authorization so that these, what was seen like abuse is not actually allowed anymore, at least in West Virginia.…