CommonSpirit Sets Five Benchmarks for Payer Prior Authorization Reform Progress
CommonSpirit Health has established five targets to evaluate health plan progress on prior authorization reform following 2024 federal interoperability and prior authorization rules. The health system announced it has reached a milestone with Humana on these metrics. The 2024 regulation required insurers to begin reporting prior authorization data, but CommonSpirit argues the aggregated data lacks operational context for providers. The benchmarks aim to measure meaningful improvement in prior authorization processes beyond raw data reporting.
Provider-driven accountability metrics for prior authorization reform could influence how Medicaid managed care plans implement CMS's prior authorization transparency requirements and shape contract negotiations.
Managed Care
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