UnitedHealth Vows to Reduce Prior Authorization Burden

In last week’s call with investors, Andrew Witty, CEO of UnitedHealth Group, acknowledged the need for better healthcare outcomes and how the system needs to be less confusing and less complex. During his prepared remarks, Witty that more needs to be done to improve quality and health outcomes while lowering costs for patients. He believes there are opportunities to improve the system through value based care.

“People’s health interactions should be as intuitive and seamless as every other aspect of their lives, banking, shopping, streaming,” he said. “This past year, we saw an extraordinary increase in the use of these modern channels. We know there is still a large gap there, and we intend to keep at it until it is closed.”

Witty also promised that UnitedHealthcare would work to speed up turnaround times for approval of procedures and services for Medicare Advantage patients, and to reduce the overall number of prior authorizations used for certain Medicare Advantage services. “Some of this work we can do on our own, and we're doing it, but we're encouraged also by industry and policymaker interests in solving for this particular friction across the whole system. Ultimately, improving healthcare means addressing the root cause of healthcare costs,” he said.

Bruce A. Scott, M.D.

Bruce A. Scott, M.D., president of The American Medical Association (AMA), said in a statement Witty’s vow to address prior authorization, but “improving the prior authorization process requires meaningful actions like significantly reducing the volume of requirements, using transparent and evidenced-based clinical criteria, ensuring that qualified physicians are the only ones making denials, and requiring that decisions are made within hours, not days or weeks.”

Scott also pointed that these reforms must be made across all markets, including self-funded plans.

In 2018, the AMA, the insurer trade group AHIP, Blue Cross Blue Shield Association, American Hospital Association, American Pharmacists Association and Medical Group Management Association released a Consensus Statement with the goal of improving the prior authorization process.

Related: Physicians Say Prior Authorization Leads to Bad Outcomes

But a survey of physicians by the AMA released in August 2024 found that not much had changed. The AMA surveyed 1,000 physicians and found that almost 90% of them reported that prior authorization interfered with continuity of care. UnitedHealthcare topped the list as the list with highest burden on physicians for prior authorization, according to the AMA survey.

Related: Prior Authorization Denials in Medicare Advantage Plans Increasing

Additionally, a review issued in August 2024 by KFF found that in Medicare Advantage plans almost all enrollees are required to obtain prior authorization for some services. Medicare Advantage plans, KFF found, denied 3.4 million prior authorization requests for healthcare services in whole or in part in 2022, or 7.4% of the 46.2 million requests submitted, according to the KFF analysis of federal data. Higher cost services, such as inpatient hospital stays, skilled nursing facility stays, and chemotherapy, are often subject to prior authorization in Medicare Advantage plans. Traditional Medicare requires prior authorization on a limited set of services.

UnitedHealth Group in particular has come under scrutiny for its use of AI to review and deny claims. In November 2023, a lawsuit was filed against the insurer that claims its division NaviHealth used AI to deny claims in Medicare Advantage plans.

The killing of UnitedHealthcare CEO Brian Thompson in December 2024 has brought renewed attention to the healthcare industry’s practices. A Gallup survey released just after the shooting, but conducted in November 2024, found that the percentage of U.S. adults who say the quality of healthcare is excellent or good is down by a total of 10 percentage points since 2020. Much of the dissatisfaction is related to the cost and access of healthcare.

Regarding prior authorization, the AMA found that just 23% of physicians reported that their electronic health system offers electronic prior authorization for prescription medications. Physicians said the phone was the most common method used to complete prior authorizations.

A new rule from the Centers for Medicare & Medicaid Services (CMS) could help. CMS issued a final rule in January 2024 that requires health plans to offer electronic prior authorization technology that directly integrates with electronic health records. As part of this new rule, beginning in 2026, Medicare plans will be required to send prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests for medical items and services.