AI-powered prior authorization can streamline patient care, reduce abandonment, and enhance provider efficiency, ensuring timely treatment and improved health outcomes.

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 report seeing 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.

Published On: May 14th, 2025Categories: AI/ML National Media, News

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About the Author: Traci Granston M.D.

Dr. Granston serves as the Senior Vice President and Senior Medical Director of Clinical Strategy for Musculoskeletal at Cohere Health. She is an orthopedic surgeon based in Washington who specializes in hand surgery and practiced at Proliance Orthopedic Surgeons for 22 years. She attended medical school at Vanderbilt University. She completed her residency in Orthopedic Surgery at Case Western Reserve University School of Medicine and a Hand and Microvascular Fellowship at University of Washington School of Medicine. Dr. Granston earned her executive M.B.A. from the University of Washington Foster School of Business. She is currently a fellow of AAOS, and also serves on a cabinet at Vanderbilt University School of Medicine dedicated to raising capital for students who may struggle with affording tuition.