A Simpler Path to Care for Ohioans
No one goes into medicine because they want to spend more time on paperwork. Yet for many physicians today, navigating the administrative demands of our healthcare system has become an unavoidable part of delivering care. As Ohio lawmakers debate reforms to improve our system, including the prior authorization process, we have an opportunity to ask an important question: How can we meaningfully reduce barriers to timely, accessible care?
As Aetna’s deputy chief medical officer, and a physician myself, I understand how burdensome prior authorization can be. I always want to spend my time caring for patients, not dealing with excessive paperwork, duplicative documentation, or administrative processes. When those requirements delay a clinician’s ability to deliver appropriate care, frustration is understandable. They should be able to trust that their clinical judgment will receive fair and timely consideration and that the process will be clear, predictable, and manageable.
At Aetna, we’ve heard these concerns and have worked to simplify prior authorization by reducing requirements, accelerating response times, and streamlining reviews for more complex care. We have a responsibility to make sure that the treatments, tests, and procedures we cover are medically necessary, evidence-based, and appropriate. Fulfilling that responsibility also means recognizing when prior authorization gets in the way of timely care.
There is broad agreement that the process can — and must — work better. To improve the clinician’s experience and better support the member, the path forward should focus on three things: 1) combining related prior authorizations so clinicians don’t have to submit separate requests at every step of care; 2) improving data sharing so more requests can be approved in real time; and 3) limiting the number of services that require prior authorization in the first place. These are practical steps that can reduce administrative burden, give providers more time with patients, and make the process work better for all.
Aetna continues to have the fewest medical services subject to prior authorization among national health plans. We’re also one of the first large national health insurers to combine pharmacy prescriptions and medical procedures into a single clinical review for certain complex conditions, reducing unnecessary administrative steps for clinicians.
We review our prior authorization requirements every year to ensure they remain clinically appropriate. We’re also working with other health plans to develop common standards for electronic prior authorization, so providers have a consistent process regardless of the insurer. We’re investing in digital tools like the Aetna Health app to give members greater visibility into the status of their prior authorization requests.
These steps are delivering measurable progress. We approve more than 95 percent of eligible prior authorization requests within 24 hours, with many completed even sooner. Across our commercial and Medicare businesses, 82 percent of electronic prior authorization requests are approved in real time.
At the same time, standardizing and simplifying the process doesn’t mean compromising clinical judgment. To be clear, Aetna never automates medical necessity denials. Requests involving medical necessity continue to be reviewed by appropriately licensed clinicians with expertise relevant to the condition or treatment being considered.
As a physician and health plan leader, I know there’s still more work to do. Improving prior authorization will require continued collaboration across the healthcare system, and no single organization can solve every challenge alone. I’m committed to continuing that work—listening to providers, streamlining the process where we can, and earning the trust that’s essential to delivering timely, evidence-based care for Ohioans.
Dr. Chris Jagmin is Aetna’s deputy chief medical officer. His work focuses on improving quality, advancing affordability, and delivering better experiences for Aetna’s 26 million members with a specific focus on reducing friction for members and providers with the prior authorization process.
