Healthcare leaders have heard the promises before. Faster approvals, less red tape, fewer delays. But staff are still drowning in paper work, patients are still waiting, and the system still isn't working.

1. The mounting frustration

Coverage & complexity:
Insurers cover 250 million+ Americans and have pledged to reduce prior auth delays. But CEOs aren’t convinced.

“We’ve heard similar commitments before.”
– Marna Borgstrom, former CEO, Yale New Haven Health
Becker’s Hospital Review

Skeptical leadership:
Automation isn’t the magic bullet if it just accelerates the wrong things.

“The concern is that it may allow insurance companies to issue denials faster.”
– Chris Van Gorder, CEO, Scripps Health
Becker’s Hospital Review

Burnout magnet:
At University Hospitals, staff process over 165,000 prior auth requests a year for CT and MRI even though less than 1% are ultimately denied.

“If less than 1% are ultimately denied, why are we spending this amount of time?”
– Dr. Paul Hinchey, COO, University Hospitals
Becker’s Hospital Review

2. The disconnect between promises and outcomes

What payers are promising:

• Faster approvals
• Fewer hurdles
• Cross-plan consistency

What providers are seeing:

• Digital tools: New integrations are making a difference in certain specialties, but leaders point out that these pilots are limited in scope and haven’t moved the needle system-wide. Becker's Hospital Review
• Scant improvement: In Texas, a recent rollout of electronic prior auth tools led to measurable benefits for only 3% of clinicians over six months. That included slightly faster response times but not enough to reduce overall burden or meaningfully change workflows. Becker's Hospital Review
• Replay risk: Without penalties, "voluntary reform" may just shift denials downstream Becker's Hospital Review

250 M+ Americans impacted by insurer commitments

165K PA cases/year at U Hospitals with < 1% true denials

Only 3% clinician relief seen in early Texas rollout

3. Ethermed’s take: Reform won’t work without accountability and alignment

Accountability over promises

• Voluntary pledges fall flat without measurable metrics or enforcement.
• Ethermed advocates for clear KPIs and transparency at every stage.

Harmonization + automation

• Prior authorizations are tangled in overlapping portals and varying data sets.
• We’re building interoperable tools that bring consistency to prior auth no matter the plan, system, or data format.

Clinician-first design

• Reform isn’t just a tech problem, it’s a people problem. If it doesn’t work for the clinicians doing the work, it doesn’t work.
• Ethermed is built with and for the care teams who live inside these workflows. We don’t ask them to log into another portal or learn a new system. We embed into the tools they already use and quietly handle the authorization work behind the scenes. That means less clicking, less chasing, and fewer hours lost to paperwork.

Focus on patient impact

• Reform success isn’t about surface-level improvements, it’s about whether patients get care faster, with fewer delays or disruptions.
• At Ethermed, we look beyond implementation metrics. We track whether patients are getting scheduled sooner, whether denials are dropping, and whether care teams are freed up to focus on clinical needs, not clerical tasks.

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Final thought

The latest wave of prior-authorization reform sounds promising but we’ve seen how often that promise stalls out. We’re focused on what actually moves the needle:

• Commitments that are measurable and enforceable
• Integration that fits into existing systems, not around them
• Pilots that prove real impact for both clinicians and patients

We’re not here to add another layer of tech. We’re here to remove the friction, behind the scenes so care teams can do what they do best, and patients get the care they need without delay.

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