Improving patient outcomes with intelligent prior authorization

Updated on February 4, 2025

Within healthcare, the prior authorization process has long been seen as an important yet contentious aspect of care delivery. While effective for ensuring treatments align with evidence-based protocols and also controlling costs, prior authorization also leads to unintended consequences. This process has morphed into a burdensome and time-consuming administrative hurdle for physicians and a barrier to timely and necessary care for patients. Instead of enhancing care, outdated paper-based methods can delay treatments, increase administrative burden, and contribute to physician burnout.

For many physicians, the frustration of navigating prior authorization is a daily struggle, jeopardizing patient outcomes and straining an already overextended healthcare system. Physicians and their staff are overwhelmed by the time-consuming process: on average, a practice completes 43 prior authorization requests per physician, per week, and this hefty administrative burden often requires staff who work exclusively on prior authorization. Such delays can hinder patients’ access to care and impact their clinical outcomes. As these challenges intensify, the industry is seeking innovative solutions to transform this outdated process and restore physicians’ focus on patient care.

The not-so-hidden cost of prior authorization

A startling 93% of physicians report regular burnout, with nearly half considering leaving the field. Overwhelming administrative burdens, staffing shortages, and evolving patient experience expectations are fueling this burnout epidemic, leaving healthcare systems and patients with the aftershocks of more limited care options and a care system in need of change.

The human cost of prior authorization cannot be ignored. Delays in care approvals can have severe consequences for a patient’s health and well-being. Whether it’s necessary care or essential medication, any delay can lead to a decline in a patient’s condition. Chronic illnesses, in particular, require prompt and consistent treatment. Waiting days or weeks for approval can transform manageable conditions into severe, costly health crises. 

According to the American Medical Association (AMA) survey, 88% of physicians reported that prior authorization compromised the continuity of care, and 59% said it sometimes or often destabilized patients whose conditions had been previously stabilized with particular treatment plans. This constant tension between administrative demands and patients’ needs further contributes to physician burnout. Reducing this burden is not just a matter of improving workflow efficiency—it’s about improving patient care outcomes and ensuring physicians can focus on their most important role: caring for their patients.

The power of partnership: AI and clinical expertise

As healthcare evolves, so must the tools used to support its evolution. AI is one of the most promising innovations in the prior authorization process, but it must be used responsibly. While AI is a powerful tool, it is not a standalone solution; the true power of AI in healthcare is unlocked when it works in tandem with clinical expertise. Physicians must remain at the heart of decision-making, using AI-driven insights to help inform their care strategies and steer patients toward the most efficient care paths. This ensures that patient care is tailored to individual needs while still adhering to the highest standards of evidence-based medicine.

One of the most notable outcomes of this shift is the reduction in care abandonment. Patients are more likely to follow through with their treatments when they receive faster approvals, leading to better health outcomes and fewer costly complications or hospitalizations. AI-driven prior authorization can alleviate physician burnout by automating many of the routine aspects of the process. In fact, some health plans report an 89% automatic approval rate when using an intelligent prior authorization platform.

This is particularly impactful for smaller practices, where resources are often limited. With fewer staff dedicated solely to handling prior authorizations, practices can allocate their time and workforce to more productive tasks (such as returning patients’ phone calls), thus improving efficiency and job satisfaction. The result is a more sustainable work environment that can focus more on delivering quality care and less on navigating a complex web of administrative red tape. By leveraging intelligent prior authorization, providers reported spending 35% less time on prior authorization submissions, in turn enabling them to schedule their patients’ care five days faster.

A collaborative approach to healthcare innovation

While AI offers significant benefits to physicians and the larger healthcare system, the success of any intelligent prior authorization solution depends on blending technology with clinical expertise. When employed responsibly, AI will not replace physicians or the art of medicine, but rather will accelerate the path to an appropriate ‘yes,’ benefiting providers, health plans, and patients alike. Physicians must also play a key role in shaping AI models to align with best practices and patient needs, turning intelligent prior authorization into a powerful tool for reducing administrative burden and improving patient care. And by freeing up more time and resources for patient care, both the provider experience and patient outcomes will improve.

Ultimately, integrating AI into prior authorization reflects a broader healthcare shift toward innovation that reduces inefficiencies, improves outcomes, and supports physician well-being. As more practices adopt these tools, prior authorization can transform into a smoother, more efficient process that benefits all involved.

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Traci Granston
Dr. Traci Granston
SVP of Clinical Strategy at 

Dr. Traci Granston is SVP of Clinical Strategy at Cohere Health.