Few phrases raise blood pressure among doctors and patients like “prior authorization.” Ask any clinician and you’ll hear the same story: delayed treatments, endless back-and-forth, and vulnerable individuals left waiting while paperwork wins the day.
For providers, prior authorizations are a constant drain of time and energy. For patients, they can mean worsening conditions, missed windows for effective treatment, or even care that never arrives at all. And for payers, prior authorizations are a blunt instrument used to control expenditures and enforce documentation—sometimes creating tension with the very clinicians trying to deliver timely care.
These challenges have sparked a race toward solutions that promise speed. Automation and now AI are held up as saviors: fewer clicks, faster responses, reduced administrative burden. Yes, efficiency matters, but let’s be honest. Faster prior authorizations won’t happen if the purpose of them is to block, delay, or deny care. There’s a reason prior auths aren’t speedy—the delay might be a ‘feature,’ not a bug.
Speed alone won’t fix the problem. In fact, rushing a broken process could even make things worse.
Prior Auth Isn’t a Speed Problem—It’s a Systems Problem
Keystrokes aren’t the real source of delay. The core issue is competing incentives. Clinicians gauge success by how quickly and safely they can start treatment, while payers measure it by how effectively they can contain costs and enforce compliance.
Those aims collide every day, leaving physicians in the exhausting position of chasing approvals while trying to keep patients front and center. The result is predictable: friction, distrust, and patients waiting in limbo.
This dilemma has fueled a rush toward technology, with promises to cut manual entry, process requests faster, and get approvals moving. But here’s the trap: adding more volume and faster processing to an already misaligned system doesn’t make it better. It magnifies the dysfunction. If the underlying workflows remain misaligned, scaling just compounds the wrong outcomes.
And while technology can certainly help, we need to be realistic about the nature of the problem. Healthcare at large lacks both technical interoperability and business interoperability, while the incentives of payers and providers remain fundamentally misaligned.
Until both are addressed, new tools will at best nibble at the edges and at worst add fuel to the fire.
Why Automation Alone Can Make Things Worse
The appeal of accelerating prior authorizations with technology is obvious. On average, they consume 12 hours of staff time every week, so automating approvals or denials feels like a relief. Bots can click the right fields, auto-fill forms, and move requests through the queue faster than a human ever could. On the surface, this looks like progress.
But drop AI into the realm of misaligned incentives, and what happens? You might get faster denials. More duplicate requests. Even less time for clinicians to focus on actual patient care, as teams are forced to chase down exceptions, resubmit documentation, or appeal decisions that never should have been denied in the first place. What looks like “efficiency” on paper can, in practice, push more administrative burden back onto the same providers already stretched thin.
For patients, the effect is dangerous. Faster denials can mean longer waits, more uncertainty, and greater risk of conditions worsening while the system sorts itself out. In other words, technology applied without fixing systemic gaps doesn’t remove friction, but multiplies it.
Imagine paving a six-lane highway between two cities without agreeing on which side of the road to drive on. You’ll move cars faster at a greater risk of increasing accident rates.
That’s why automation can’t be the endgame. To build something better, we have to step back from the tools themselves and look at the foundation: how people, processes, and technology fit together. Without that alignment, no amount of speed will move care forward.
People, Processes, and Tech—In That Order
The process of prior authorizations won’t be improved with shinier tools alone. The healthcare ecosystem must rethink its order of operations: people, processes, then technology. Too often, the industry starts with tech and hopes the rest will follow. That’s why the same frustrations keep resurfacing.
- People. Patients, providers, and payers all need visibility and accountability. Trust can only be forged when everyone sees the same rules applied consistently, regardless of which side they’re on. Without that foundation, every prior authorization feels like a negotiation instead of a standard.
- Processes. Workflows must be redesigned to reward collaboration, not competition. If each side is still protecting its own interests, then automation simply accelerates conflicts. When processes are structured around shared outcomes—like timely access to quality care—disputes shrink and trust grows.
- Technology. Only after people and processes are aligned does technology create real value. That’s when we move beyond bots that push paper and create real partnerships that support clinicians, flag true exceptions, and eliminate the work no one should be doing in the first place.
The Role of AI—When It Helps
AI has promise, but only when applied to aligned workflows. Used in the wrong context, it just reinforces silos and accelerates the wrong work. For example, if two departments unknowingly submit the same request, automation can push both through the system without question, clogging the process instead of fixing it.
Used correctly, though, AI enhances trust-based systems. It can flag those very duplicates before they waste time, highlight true exceptions that need human review, and streamline routine approvals everyone already agrees on.
When technology is applied correctly to an aligned system, authorization decisions become steadier, more transparent, and far easier for patients and providers to rely on.
Prior Authorization as a Warning Light
Like a warning light on a dashboard, prior authorization signals a deeper systemic problem. Prior authorization often gets the spotlight, but the real issue runs deeper. The same inefficiencies that hold up approvals also slow referrals, delay discharges, and complicate transitions of care.
For example, a physician may finally secure an approval only to face a new set of barriers in transferring a patient to the right facility. A post-acute provider may accept the referral, only to discover the documentation hasn’t been followed. Each step becomes another waiting room.
Looking at prior authorization on its own narrows the problem too much. The bigger opportunity is aligning incentives across the full continuum of care. When payers, providers, and post-acute partners share accountability, authorizations move faster. More importantly, patients proceed through the system with fewer setbacks at every stage.
In our work with major health systems, care managers have a better balance of control of the prior authorization process with post-acute providers, gaining new visibility into where requests stand. With clearer insight into denial rates and turnaround times, they’re not only protecting patients from unnecessary delays but also equipping themselves with the data needed to strengthen payer contracting conversations.
Lessons for Health Tech Leaders and the Path Forward
If you’re building solutions in healthcare, here’s the takeaway: don’t bolt clever tools onto broken workflows. Align incentives. Build governance into the system. Create structures where collaboration is rewarded. Go back to first principles.
Speed is nice. But fairness, transparency, and accountability are non-negotiable. And what’s right shouldn’t be sacrificed for what’s fast.
Bots won’t fix prior authorizations. We need a better system—one built on trusted, rules-based relationships where all sides share responsibility for getting patients the right care, at the right time, every time.
About Russell Graney
Russell Graney is the Founder and CEO of Aidin, a platform dedicated to simplifying care management and improving care transitions. He began his career at Bain & Company, advising Fortune 50 companies, and later co-founded a charter school in Brooklyn that now serves over 600 students annually. Motivated by his uncle’s diagnosis of early-onset Alzheimer’s, Russell left private equity to create Aidin.
