Prior Authorization in the Value-Based Care Era: Roadblocks and Opportunities
- Prior authorization slows value-based care — though meant to control costs, it delays treatment, adds admin burden, and risks patient outcomes and revenue.
- Heavy administrative load — providers lose up to 16 hours weekly on approvals instead of patient care, struggling with complex, ever-changing payer rules.
- Financial & operational risks — delays and denials lead to lost revenue and hinder adoption of value-based models.
- Positive 2025 trends — electronic prior authorization (ePA), AI-driven tools, and gold carding programs are cutting delays and improving accuracy.
- Opportunities ahead — automate PA workflows, track denials to negotiate better terms, and enhance patient transparency for stronger trust and results.
- Practolytics advantage — automation, error-free submissions, rule alerts, and expert support that turn PA roadblocks into strategic wins for value-based care success.