Maria Russo, MBA

We need a more streamlined way to answer the question, "If a provider performed a healthcare service for a patient, would the health plan authorize payment?" Too many paper pushers are involved in a high-stakes game of Mother-May-I, and patients suffer waiting around for permission to receive care.   When asked publicly, everyone says that automating health plan's prior authorization decisions would be amazing for provider organizations, health plans, and patients. Why then is adoption so low?   Here are four reasons I could come up with: ⏳ The implementation deadline still seems a ways off - The CMS Interop and Prior Authorization Rule requires that health plans have a prior auth API in place by Jan 1, 2027, and providers eligible for the MIPS government program must be able to request prior auth electronically by the same date. Other priorities may seem more pressing. Some payers may be hoping this rule gets pushed off a couple years, but it's going to happen eventually, and getting the technology in place and testing it will take time. 20%-30% of people are chronic procrastinators, even when putting off a project will have negative consequences.   🤔 Confusion around the EHRs' proprietary products - Some EHRs are working on proprietary products with prior auth functionality and selling them to health plans. The problem is that these products will only meet a provider's prior auth needs if all that provider's health plans purchase the platform. If any of a provider's health plans choose not to buy it, then that provider will also need to a payer-agnostic solution. Sadly, many providers mistakenly believe the EHRs will solve prior auth for them.   🙅 No viable products in the market today - I don't know of any prior auth products that can be easily embedded in certified EHRs and that are already connected to multiple health plans. Some provider organizations are waiting to pull the trigger on prior auth functionality until a product with multiple connections to payers is in place. I hear Cognizant has a payer-agnostic app in the works, which is exciting because they are already connected to over 80% of the health plans.   🤖 Few health plans have the technology in place today - To streamline the process, the providers' prior auth apps must be able to connect to their health plans, but the plans do not have their systems in place yet. Why not? Well, some health plan executives are wary that automating prior authorization could lead to more approved healthcare services for their members, which could hurt their bottom lines. Digitizing health plan policies to authorize payment for healthcare services also takes time. Because modernizing prior auth is complicated and comes with some risk, some payers are putting it off until the compliance deadline gets closer. So, what do you think? Are there other good reasons for us to keep prior auth in the 1900s? #PriorAuthorization #FHIR #HL7

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Bottom line up front (BLUF): clinician engagement is foundational to healthcare supply chain efficiency and cost containment. 🔎 Who drives the majority of healthcare supply chain costs? In most health systems, it isn’t administrators, vendors, or finance teams—it’s clinicians - more specifically, clinical decision-making. 👉Let’s look at some details: Clinical decisions made every day at the bedside and in the operating room directly or indirectly shape over 80% of all supply, implant, and pharmaceutical costs. That includes: - Surgical implant and disposable supply selection - Device vendor preferences - Prescribing patterns - The care pathways that dictate overall resource utilization In other words: the supply chain isn’t just a back-office function. It’s the direct result of thousands of clinician-level decisions made in real time. Here’s the challenge: when those decisions are not made with cost-effectiveness in mind (and often they are not), the result is highly variable and often unnecessary spending. 💡 However, the solution is not restriction of clinical autonomy—it’s engagement of clinicians as partners. Possible? Well, a recent McKinsey & Company's survey of 150 physicians across multiple specialties found that over 80% of physicians believe they can reduce supply costs without affecting quality, and view managing supply costs as part of their responsibility. Furthermore, DOCSI's internal data shows a consistent 85%+ clinician engagement rate with its digital supply chain platform. Clinicians, as usual, want to be part of the solution. When physicians are empowered with transparent cost data, peer comparisons, and actionable insights, health systems achieve 5–15% reductions in supply and implant expenses—without compromising quality or outcomes. For large organizations, that translates into tens of millions of dollars in annual savings—savings that can be reinvested into patient care, staff support, and long-term sustainability. ✅ Physicians maintain clinical autonomy ✅ Executives achieve real financial impact ✅ Patients benefit from more efficient, sustainable care Hospitals that bring physicians into the process—not just as end-users but as strategic decision-makers—are the ones positioned to thrive in today’s margin-compressed environment. —----------------------------------------------------------- What is your experience with engaging physicians in supply chain? What tactics have you used successfully? What results have you seen from clinical engagement?

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