Becker’s Healthcare Podcast Inside the Payer Shift: Prior Auth Reform and the Rise of ICHRAs with Jakob Emerson
Jun 26, 2025
Jacob Emerson, Associate News Director at Becker’s Healthcare, dives into pivotal changes in prior authorization practices among insurers. He discusses the heated debate surrounding these reforms, highlighting providers' skepticism about their effectiveness. Emerson also sheds light on the rise of Individual Coverage Health Reimbursement Arrangements (ICHRAs) and how they are fundamentally reshaping the commercial payer landscape. The conversation emphasizes the need for health systems to adapt to these evolving insurance models as they influence future reimbursement strategies.
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Prior Authorization's Financial Role
- Prior authorization is used by insurers to control care costs and protect shareholders' interests.
- Completely eliminating it would require congressional law due to private insurer policies.
Major Insurers' Prior Approval Reform
- 50 insurers have voluntarily committed to streamline prior authorization by 2027 with e-submissions and real-time approvals.
- These reforms will also improve authorization transfers and appeals across Medicare Advantage, Medicaid, and commercial plans.
Skepticism Over Voluntary Reforms
- The new prior authorization reforms are voluntary and lack regulatory enforcement.
- Providers are skeptical, predicting new costs and retrospective denials as insurers maintain cost control.