Healthcare Leaders and HHS Unite to Redesign Prior Authorization

SAN JUAN, Puerto Rico – February 25, 2026 – In a concerted effort to mend one of the most fractured components of the American healthcare system, senior leaders from across the industry converged this week for Abarca Forward 2026. The event, hosted by healthcare technology company Abarca Health, moved beyond typical conference rhetoric to collaboratively draft a new playbook for the future of prior authorization (PA) and utilization management (UM).

The initiative tackles a process that has become a significant source of friction and frustration for nearly everyone it touches. "Prior authorization is the one part of healthcare that almost everyone agrees feels broken. Painful for patients, burdensome for providers, and expensive for plans," said Jason Borschow, CEO of Abarca Health, in his opening remarks. This year's gathering aimed to transform PA from a widely despised administrative hurdle into an intelligent clinical decision-support tool.

The Universal Pain Point of Prior Authorization

The urgency for such a redesign is underscored by a mountain of evidence detailing the system's failures. Originally intended to ensure clinically appropriate and cost-effective care, PA has devolved into a major driver of administrative waste and, in the worst cases, patient harm.

Recent surveys from the American Medical Association (AMA) paint a grim picture, with over 90% of physicians reporting that PA processes lead to delays in necessary care. Critically, nearly one-third of those doctors have seen these delays result in serious adverse events for patients, including hospitalization, permanent impairment, or even death. Patients are often caught in the crossfire, with studies showing that a significant percentage abandon treatment altogether when faced with complex and slow authorization hurdles.

For providers, the burden is immense. Medical practices now dedicate substantial staff hours—in some cases, entire full-time positions—just to navigate the labyrinth of varying payer rules and submit PA requests. The cost of this administrative churn is staggering, particularly for manual submissions, which are vastly more expensive and time-consuming than their electronic counterparts. This bureaucratic overload is a leading contributor to physician burnout and diverts precious resources away from direct patient care.

The problem is exacerbated by a fragmented landscape where each health plan may have its own unique and often opaque criteria for approvals, creating a nearly impossible compliance challenge for providers who work with multiple payers.

A Collaborative 'Anti-Conference' Seeks a Redesign

Recognizing that siloed efforts have failed to produce meaningful change, Abarca Forward 2026 adopted an 'anti-conference' format. Traditional panel discussions were replaced with curated co-creation sessions that brought together executives from health plans, provider groups, pharmacies, pharmaceutical manufacturers, technology firms, and major employers. This diverse coalition was tasked with aligning on core principles and tangible strategies for a new PA model.

"The solution isn't just automation. It's redesign," Borschow emphasized. "We need a smarter system where data, incentives, and clinical judgment are aligned so that coverage decisions are fast, transparent, and supported, not adversarial."

The event featured insights from a wide array of industry innovators, including Tanvi Patel of Amazon Pharmacy, Suzanne Trautman from Blue Cross NC, and John Barto of Microsoft, among others. Sessions explored the practical application of AI in modernizing workflows, integrating real-time benefit information at the point of care, and managing the complexities of high-cost specialty drugs.

Federal Scrutiny and the Push for Modernization

The industry's collaborative push for reform is occurring in lockstep with mounting pressure from federal regulators. A key session at the event featured a one-on-one discussion between Borschow and Chris Klomp, Chief Counselor at the U.S. Department of Health and Human Services (HHS). Klomp, who oversees all Department operations, shared the federal perspective on the future of utilization management and the government's role in standardizing electronic PA.

This dialogue is particularly timely. The Centers for Medicare & Medicaid Services (CMS) recently finalized its Interoperability and Prior Authorization Final Rule, which sets a January 1, 2026, deadline for many payers—including Medicare Advantage and Medicaid plans—to implement significant changes. The rule mandates that payers must provide a specific reason for any PA denial and drastically shortens decision timeframes to 72 hours for urgent requests and seven calendar days for standard ones.

Perhaps most consequentially, the rule requires impacted payers to implement a standardized electronic Prior Authorization API using the HL7 FHIR standard. This technological mandate is designed to enable seamless, automated communication between provider and payer systems, directly addressing the administrative inefficiency that plagues the current process. Klomp noted that policy is now actively "catching up to innovation," signaling a receptive federal environment for the very solutions being workshopped at the event.

The 'Playbook' for Coordinated Action

The culmination of Abarca Forward 2026 was the creation of a tangible 'playbook.' This document, developed jointly by the competing and complementary stakeholders in the room, outlines shared principles and a strategic roadmap for implementing a next-generation PA model. The goal is to provide a unified guide that can help move the entire industry from circular debates to coordinated, meaningful action.

By bringing plans, providers, employers, and technology leaders into a single room to hash out the patient journey, the event aimed to build a foundation of trust and shared purpose. The resulting playbook is intended to guide participants' future work, creating a ripple effect as they return to their respective organizations with a common framework for change.

While the long-term impact remains to be seen, the collaborative development of this playbook, combined with the tailwind of federal regulation, represents one of the most promising movements toward fixing prior authorization in years. The industry will be watching closely to see if this blueprint can finally deliver on the promise of a PA system that is faster, more transparent, and ultimately more humane.