Reducing care abandonment with AI-powered prior authorization

Traci Granston: ©Cohere Health

For providers, prior authorization remains one of the most frustrating aspects of modern medical practice. This administrative process, originally designed to ensure that treatments align with evidence-based care, often introduces delays in patient care, consumes hours of staff time, and leads to care abandonment. A recent American Medical Association survey revealed that providers and their staff spend an average of 12 hours a week on completing prior authorizations, and 35% of respondents have staff who work exclusively on prior authorizations.

The burden is even more pronounced in small, independent practices, where an average of 43 prior authorizations per provider are processed weekly. The administrative tasks providers face with traditional prior authorization processes often divert valuable time away from care delivery. The inefficiencies also extend beyond the administrative workload—providers face the serious challenge of disrupted care, with untreated conditions potentially leading to long-term health consequences.

Adding to these pressures, 78% of physicians reportseeing patients abandon treatments due to prior authorization hurdles. Care delays not only jeopardize patient health but also increase healthcare costs, as untreated conditions often worsen. There's a pressing need to find solutions for those on the front lines of care.

Reducing care abandonment
The consequences of delayed care can be severe. When patients face extended wait times, sometimes weeks, for treatment approval, they may abandon the recommended course of action. In the best cases, this means delayed recovery; in the worst, untreated conditions may escalate to more complex, life-threatening, and expensive situations. This directly reduces a patient's quality of life. Depending on the patient’s health condition, delayed care can lead to increased pain and suffering and even long-term disabilities. For primary care physicians and specialists, this is a constant concern, as patients with chronic conditions are especially vulnerable to the risks of delayed care.

Traditional prior authorization processes, with their burdensome administrative requirements, can contribute to this issue. Research has shown that more than two-thirds of providers believe these policies lead to unnecessary office visits and ineffective treatments.

Fortunately, AI-powered prior authorization systems can help reduce care abandonment by improving the speed and accuracy of approvals. By ensuring patients receive timely approvals for necessary treatments, these systems increase the likelihood that patients will follow through with their care plans. This has the dual benefit of improving health outcomes and reducing the likelihood of more costly interventions later.

An optimized solution: Combining AI with clinical expertise
The traditional prior authorization process needs improvement, and intelligent prior authorization offers a transformative solution. Powered by AI and grounded in clinical expertise, this digital-first approach is reshaping the provider experience by making it easier, faster, and safer for patients to receive the care they need. AI rapidly analyzes patient data, clinical guidelines, and real-time evidence to anticipate patient needs and suggest appropriate care paths. This speeds up approvals, reduces delays, and ensures patients receive timely, high-quality care. Some health plans report an 89% immediate, automated approval rate when using an intelligent prior authorization platform.

By optimizing the authorization process, intelligent prior authorization minimizes the administrative burdens that have traditionally consumed hours of staff time. Providers can focus on direct patient care and reclaim time previously spent on administrative tasks. While AI processes data, providers remain central to decision-making, ensuring their clinical expertise guides patient care in collaboration with advanced technology.

Beyond reducing administrative workload, intelligent prior authorization can significantly improve workflow efficiency, enhancing patient outcomes while alleviating burnout and improving the provider experience. AI-powered intelligent prior authorization platform offers a path forward for a health care system increasingly driven by efficiency and clinical excellence. According to a recent AMA survey, prior authorization is a key contributor to burnout, making this technology-driven solution an essential tool for enhancing provider well-being and improving patient care.

The role of providers in driving change

While AI offers substantial improvements, the success of any prior authorization system still depends on provider involvement. The most effective systems blend cutting-edge technology with clinical expertise.

The responsible use of AI technology will never replace the work of physicians, the art of medicine, or automatically deny care. Ultimately technology accelerates the path to an appropriate ‘yes’ benefiting providers, health plans, and patients.

Physicians are key collaborators in building and training AI and ML models that align with best practices and patient-specific needs. This collaboration between technology and clinical insight makes intelligent prior authorization a powerful tool for reducing administrative burdens and improving patient care. When utilizing this technology, providers have reported being able to schedule their patients five days faster.

For those managing independent practices, adopting AI doesn't replace their expertise but enhances it. With more time to focus on patients and less time spent on administrative tasks, the provider experience and patient outcomes improve. Intelligent prior authorization offers a solution that benefits providers and their patients in a health care system increasingly driven by efficiency.

Traci Granston, MD, is vice president of clinical strategy at Cohere Health