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Becker’s Healthcare Podcast
Inside Healthcare’s Hottest Topics: Prior Authorization Reform and Smart Tech Innovation with Alan Condon & Laura Dyrda
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- [00:01]
Laura Dearda
Exciting things are happening at Beckers Healthcare Stay ahead of industry trends with the new Beckers CFO plus Revenue Cycle Podcast your go to source for insights from top healthcare finance leaders. Tune in wherever you get your podcasts and don't miss the 10th annual Health IT Digital Health RCM Conference happening September 30 to October 3, 2025 in Chicago. Join thousands of executives, engage with industry leaders and explore the future of healthcare innov. Learn more about our upcoming events@beckershospitalreview.com See you there. This is Laura Dearda with the Becker's Healthcare Podcast. I'm thrilled today to be joined by Becker's Editor in Chief, Alan Condent, who is going to talk a little bit about some of the big news of the day. Right now we're really focusing in closely on some of the news coming out of Washington, D.C. as insurance companies have agreed to make some changes around the prior authorization process. So Alan, I'll let you take it away. Can you tell us a little bit about what's happened over the past, you know, 24, 48 hours or so and how some of the key stakeholders are responding?
- [01:08]
Alan Condent
Yeah, absolutely. And always a pleasure to be on the podcast with you, Laura. I know we don't get to do it too often, but always a pleasure when we do. So without a doubt, like you teed me up. I think that the biggest news certainly coming out of Washington, D.C. the last couple 24 hours or so is that the broader health insurance industry really announced a series of commitments to simplify to reduce prior authorization requirements across commercial plans, Medicare Advantage and manage Medicaid plans as well. So no doubt some welcome news from providers across the board. I think the jury is still out on kind of what we'll see over the next couple years and progress that we expect to be made here. So I think some quick key takeaways just from this news here is that it pertains to nearly 50 insurers, which of those 50 insurers they cover about 257 million Americans. And a couple of those commitments which they're that they've committed to are real time electronic prior authorizations by 2027, significant reductions in prior authorizations across the board by January 1, 2026. Two other quick ones as well that they really kind of want to hone on is 90 day continuity of care when patients change their health health insurance plans. And then lastly, just to sum it all up, just clearer, faster decisions with a lot greater transparency for prior authorizations across the board. We hear time and Time again from providers when they're working on a hospital side, independent practices practices big and small, just how much of a burden prior authorization requirements have become. So no doubt a welcome reaction here. I guess just to turn to what we're hearing quickly on the provider side and from some of those on the insurance side. AHIP President and CEO Mike Tuffin, that's the trade, trade group that represents the health insurance industry, really said this is about modernizing the health insurance system, reducing those ubiquitous burdens that we see in providers across the board. But I think on the provider side, yes, certainly welcome news. But I think the big question on a lot of folks minds is will this really make a difference how soon we see this progress being made? Cms, the American Medical Group Management association was on a couple of these groups who came right out of the back in favor of this. Yes. But I think the details and the follow through on some of these commitments will definitely be key. Health systems CEOs want to be thinking will this really ease the strain on our clinicians? Are they confident that these reforms will stick and what does this really mean for hospital patients, health system patients across the board? Couple of the things that we'll be, we'll be following up on with some of our readers in the next couple of days or so.
- [03:52]
Laura Dearda
Absolutely. Thank you for the overview, Alan. And I had one question. It really stuck out to me that part of, you know, these planned updates, modernization is also in that transparency side, providing information as to why they're making policy updates or prior authorization changes, why they made a decision on the prior authorization, you know, if they're denying care or not. So is that something that, you know, you see as being helpful or beneficial at all for the providers and especially you know, thinking through what that could mean for health plans as well in their processes of moving forward. I know that's something that a lot of physicians, as you said, as well as the CFOs and CEOs you know, see as really a challenge in trying to understand, you know, why things are being denied and how they can better prepare their claims revenue cycle process. So it seems like that could be something that's really beneficial for the providers but could create some challenges for health plans as well.
- [04:52]
Alan Condent
Yeah, absolutely. And I think again I think the definitely the question of very fresh this news, definitely a welcome news. I think there's still a lot of questions out there on the provider side. On the health plan side, I think prior authorization reform is nothing really new. We've seen big, big payers in recent Years, such like United Healthcare, Cigna come to mind, have really kind of cut some of their procedures requiring prior authorization. But on the provider side, physicians haven't really seen a big difference in terms of their workload, their burden in terms of some of these prior authorization requirements. So still top of mind. Definitely some welcome news. But I think the jury's still out and we'll see as we kind of get closer throughout the end of the year into next year, we start to see some of that progress being made, what it will truly look like, what it will truly mean for patients, providers and indeed health plans as well.
- [05:45]
Laura Dearda
Got it. That's humble to know. And then I wanted to ask you as well, what are things looking like in the broader healthcare ecosystem? What trends are you seeing, especially from a hospital finance side, are you seeing, you know, what things do you see as being kind of telling from the first half of the year as we launch into the second half here?
- [06:05]
Alan Condent
Yeah, I think another great question. And again, we follow quite closely, I think one big trend, I think across the board, certainly health systems hospitals on nonprofit side, really seeing their margins, average operating margins boost kind of month over month, quarter after quarter. Unfortunately, I think whatever all eyes seem to be on Capitol Hill, on Washington, D.C. to see what exactly these proposed Medicaid cuts, Medicare cuts, ACA reform will indeed look like still being battled out within the Senate, the House. So we still really can't don't have a full grasp of what those cuts will look like. I think fair to say that there will be cuts. Just have to have to really figure out what those Medicaid cuts indeed will look like, ACR reform and whatnot. But I digress. I think health systems, given that their margins are kind of trending upwards, which is a positive sign. I think on the flip side of the script, hospital leaders, CFO CEOs are still focused on what's coming down the pipe, even though a lot of these health systems have moved their operating margins gradually into back into the positive operating margin area. I think still we're seeing some layoffs, some hospital closures being reported really at hospital systems, big and small, academic, rural, really across the country. These Medicaid cuts that are working their way through Capitol Hill no doubt will affect safety net systems. A lot more will be more devastatingly hit than maybe some of those systems that operate in more urban areas. But we've seen a couple of quick layoffs that we saw from academic systems, the likes of Vanderbilt University Medical center in Tennessee, UC San Diego Health in California, some of the two Most recent health systems that we've seen unfortunately make some cuts to their workforces as a result of some of these ongoing challenges. And one eye on what may be coming down the pipeline in terms of Medicaid cost, Laura.
- [07:59]
Laura Dearda
Absolutely. That's helpful to understand. And you know, do you expect to see more of these types of closures in staffing reductions? Anything from your perspective and from what you're hearing when you're speaking with CEOs and CFOs on a daily basis, what do you think will happen if we continue down this path over the next 6 to 12 months or so?
- [08:17]
Alan Condent
Yeah, it's a great question. It's something that came up recently, one of our panels, our virtual CEO and CFO forum. Again, we're seeing a lot of these hospital closures primarily in rural areas, not all of them, but primarily been struggling for many kind of years. When we think about where they stood before the pandemic and marching away through the pandemic, still a lot of them struggling to turn that financial corner. One opportunity that particularly rural hospital leaders seem to be flagging is the opportunity for many hospitals. Okay. Unfortunately, if they might have to shut their doors as an acute care facility, it does make a lot of sense for some of these more rural hospitals to transition into a rural emergency hospital, sacrificing some of their inpatient beds, really providing outpatient care, emergency care. Again, it sees it as an opportunity for more of these hospitals that are financially struggling to apply for that designation rather than to shut up shop entirely. So I think again, we've seen a lot of these hospitals kind of make that transition over the last two years or so and CMS made that designation available. But I think as we continue to see financial challenges and more unfortunately, hospital closures, we seem to think a lot of these hospitals still take taking a more serious, more harder look at potential designations, other ways they can keep the facility open, provide care to those, those communities, but maybe not, not as an acute care facility. So one thing that I think we expect to see as we continue to see some of these financial challenges, unfortunately hit some of these more rural communities.
- [09:52]
Laura Dearda
That's really helpful analysis. Thank you so much, Alan, for going through that. Now we can turn the tables a little bit here and I'll turn the floor over to you. What questions do you have for me? I know reporting a little bit more on the macro level as well as technology trends. And so I'll turn the floor over to you.
- [10:10]
Alan Condent
Yeah, absolutely. So I guess I'm always so, so eager to hear about you know, the technology, technology side of things. I know that's a beat that's very close to your home, that you speak to a lot of key leaders, CIOs and whatnot. In that regard, I'd be curious to just kind of hear Laura, kind of what's the latest stuff that you're hearing from CIOs, health system leaders on the technology level, kind of, whether it be AI, epic, ehr. Is anything else on the agenda that you're here? It's particularly exciting.
- [10:36]
Laura Dearda
Yeah, absolutely. Well, I think one of the things I wanted to highlight and it really kind of dovetails closely into what you were talking about is just talking about access to care. I know that's an issue that's top of mind for C suites across the board, including CEOs, CFOs, CIOs and more. And those access issues, it sounds like, especially if we're continuing to lay off staff as well as close hospitals, could worsen in the next six months to a year. But you know, those hospitals and health systems that have been able to take, take action and start thinking and planning through how they want to expand access, and a lot of that does come down to some of the technology that they're deploying in order to help them do that could make a big difference. We really heard from those speakers who are planning to attend our CEO CFO Roundtable in November that access is something that's not just a project or initiative or a one off plan, but something they're really baking into more of their mission of care in trying to create a whole strategy around what access looks like for their own organizations. For example, David Banks of Advent Health emphasized that he's designing services that account for everyday barriers to care, such as work schedules or managing chronic conditions at home. So, you know, some examples are they've been able to create an app where patients are able to have same day appointments, they're able to find their own prescriptions and refill those, they're able to access virtual care offerings and more with some of the different ways that, you know, they've been making upgrades at Advent Health. And so that's pretty exciting. And similarly at University Hospitals in Cleveland, the executive team introduced the Find My Provider tool, which is a digital decision tree tailoring physician selection based on personal preferences like location or the gender of the provider. And this project led to around a 95% success rate in appointment scheduling as well as a 6 point improvement in patient sentiment. So that real time mobile updates and streamlining navigation for patients who are trying to find a specific provider or schedule appointments has really not only boosted patient satisfaction with being able to access care, but also just the flow and efficiency of different practices within the organization. So that's definitely a win. We heard from multiple CEOs and CFOs. But then to take that to the next level, some health systems, including UVA Health, are tackling access barriers through infrastructure upgrades like discharge lounges, short stay units and other technology enabled capacity management tools. They're using predictive scheduling, expanding clinical spaces, as well as building a new hospital tower to centralize their approach for expanding access to care, especially for the broad population that they serve. And I think just finally, you know, we have seen so many organizations launch hospital at home or more home based care services beyond the traditional hospital settings. This allows patients who might have in the past stayed in hospitals for long term, several weeks, even months because they had to have specific level of monitoring or equipment attached to them that can all be transferred to the home now. And with the monitoring technologies, it's really, you know, a lot easier for patients, families to care for them, for nurses to visit and access them from remote locations and truly provide a more a better experience for them as they're trying to recover or truly figure out how they're going to be able to treat some of their challenging conditions. So it's been exciting to see how those programs have been able to build out. I know initially sometimes they're cost prohibitive, it's hard to set them up and then feel comfortable with at home monitoring versus being in the hospital. But once, you know, health systems, it seems are able to find the right partners to make this work, you know, is truly a benefit for the community as well as alleviating beds in teams within the hospital. So that's something we expect to see a lot more of is higher utilization of hospital, home for health systems that have it and then more community and regional hubs adopting these types of programs so that they can care for their patients more proactively.
- [15:14]
Alan Condent
Yeah, I mean, that's such a fascinating insight, Laura. I think something that we hear time and time again is that healthcare has an access problem. I think traditionally my head goes to creating or expanding access to care would be opening urgent cares, primary care facilities, building new hospitals. But it sounds like just as much if not more these days. It sounds like really creating expanding access is around virtual care. Like you'd mentioned remote care, things like hospital at home. Is that something that you see more and more systems investing their, their time, their energy and their resources into?
- [15:47]
Laura Dearda
Absolutely. I think you're going to see a lot more of those types of programs proliferate. I know partners including Best Buy Health and others have really made a big difference in partnering with hospitals to share their expertise as well. And then I wouldn't undercut what the patient experience, technologies and upgrades are going to do as well to help with some of those capacity challenges, the predictive analytics and more. We've also heard from smart hospitals that are being developed across the country using sensor technology so that they can alert clinical teams when a patient is actually leaving the operating room for their recovery units and whatnot. To become more efficient. The doctors don't have to alert anymore, the recovery units don't have to call and see what where they're at in the process because the sensors and video cameras are actually following the doctors and the care teams around and can make those calls based on what they note that is happening, what stage they're at in the procedure. So you know, it's those types of technologies that are making things so much more efficient. Plus the ability for patients to schedule. Patients want more control over their care. They don't want to have to call in and schedule an appointment. They want to be able to do that through their MY chart, do that through some of the other technologies online and figure out how they can, you know, create their own experience much like they do in many other aspects of their life. So I think, you know, there's going to be a lot of time and attention paid to those kinds of things by hospital and health system, C suite and strategic leaders because they're just not going to be able to, you know, hire the same type of staff and have the same kind of operating schedule with as many patients inside the hospital as they have in the past. They're going to need more and more support in the tech enabled teams that will make things more efficient. So they can do more with their current teams or more with less.
- [17:45]
Alan Condent
Yeah, absolutely. I think when you talk about the smart hospitals, the sensor technology, virtual nursing hospital, gnome, certainly exciting times we're living in when we think about the tech enabled care. But again on the financial side, no doubt some big challenges there. But again maybe that's where some of this technology can come in and help maybe alleviate some of that burden on the staffing side of things, on the other side of things to kind of help shore up some hospitals financial challenges. But certainly exciting, not yet challenging time across the board it sounds like.
- [18:16]
Laura Dearda
Absolutely. And just a couple other quick notes on the technology side. Exciting news out of Bridge. Many health systems are now familiar with their technology for ambient listening for clinical documentation. I know we've seen several systems incorporate their technology, either through pilots or official expanded rollouts and partnerships in the last year or so. Bridge reported that now it has more than 150 health systems and raised $300 million in its latest funding round to bring its valuation to around $5.3 billion, which is incredibly exciting. You know, we certainly partnered with Abridge and I've seen them grow and it's been extremely gratifying to hear from all of the physicians and health system leaders that have been able to experience their technology talk about the ways that it's made things more efficient to help clinicians become quicker with their work and alleviated the documentation burdens so they're able to spend more time with their patients, more time with their families when they're at home, and just how meaningful that is for them. And so it's been just great to see a Bridge grow and how they've been able to not only make some quick changes, integrate within epic, and then provide the type of service that really hospitals and health systems need in order to be successful. So congratulations to Abridge and then, you know, we'll see. The company says it plans with the new funding to support more than 50 million medical conversations in 2025, serving 55 specialties in 28 languages. The technology also has been shown to reduce burnout by up to 60 to 70% for clinicians, and over 90% of clinicians using say they want to continue after they start. So just a quick note there on some exciting news for a Bridge and then I wanted to note that Kaiser Permanente Ventures is among the investors in a new AI startup that's focused on medication management. The venture capital arm of California based Kaiser Permanente participated in a $30 million Series C funding round for Irene, which is a company that plans to fund and expand into specialty pharmacy management and advanced AI automation in the so just those quick two updates there, Exciting news from health technology. Always something going on and we'll look forward to continue to share what's leading edge of the industry through these updates.
- [20:49]
Alan Condent
Absolutely. I always learn something new when I jump on these podcasts, Laura. So thanks so much for inviting me on to share this with you today.
- [20:55]
Laura Dearda
Yeah, absolutely. And thank you all to our listeners. I hope this has been educational and informative. I know we'll be continuing all of these discussions, whether it's talking about some of the things Alan mentioned around Medicaid updates, other legislative policy updates, insurance companies, prior authorizations and more at our Fall events. We've got our CEO and CFO Roundtable in November as well as a Payer Issues Roundtable coming up. We've got opportunities at all of those for speaking as well as attendance and so please reach out if you'd like to be part of those events. We have a few sponsorships. It's all open, so still welcoming conversations there. And then our Health IT digital health and revenue cycle event, September 30 through October 3 is just going to be amazing. That's filling up quickly and so I, I definitely, definitely recommend acting fast if you want to be part of that. You know, we really see all of those conferences as being hugely growth oriented, focused on providers and the types of conversations that they're most engaged with. We're almost 600 speakers on the provider side at the Health IT event as well as expect 350 plus C suite, primarily CEO, CFO and COOs at our CEO CFO roundtable so, so a lot to be excited about, a lot of access to some of those elite conversations and executives and leaders from across the industry that you come to expect from Becker's digital side. You'll be able to connect virtually or, excuse me, in person with them at these events. So looking forward to that. And please do reach out to us if you've got a question or want to be part of it. We would love to talk more and continue the conversation.