After Pledging To Change, Insurers Have Cut Prior Authorizations By 11%
There's also been a 15% reduction in prior authorizations for Medicare Advantage since June, when about 50 plans signed on to the reform pledge, Fierce Healthcare reported. In other industry news: Jefferson Health sues Aetna; most Americans still prefer getting medical advice from providers over AI; and more.
Fierce Healthcare:
Insurers Have Eliminated 11% Of Prior Auths Under Reform Pledge
Last summer, the insurance industry broadly agreed to reform a major healthcare pain point: prior authorization. Now, two of the industry's leading organizations are offering a look at progress toward those goals. AHIP and the Blue Cross Blue Shield Association released a report on Tuesday that found leading health plans reduced prior authorizations for an array of services by 11% since the pledge was made. (Minemyer, 4/7)
Modern Healthcare:
Jefferson Health Sues Aetna Over ‘Downcoding' Policy
Jefferson Health sued Aetna over an inpatient payment policy the CVS Health subsidiary announced last year. Aetna in January implemented a “downcoding” policy to reduce reimbursement for some Medicare Advantage members’ hospital inpatient stays. The suit, filed Monday in the Eastern District Court of Pennsylvania, argues Aetna allegedly violated federal law and its contract with the provider when it rolled out the initiative. (DeSilva, 4/7)
Modern Healthcare:
Health Systems Embrace Performance-Based Digital Health Contracts
Health systems and health plans are embracing performance-based contracts with digital health vendors. In 2025, 75% of health plans and 61% of health systems implemented performance-based contracts with digital health vendors, according to a 2025 survey conducted by Peterson Health Technology Institute. In addition, the majority of the organizations that didn’t use performance-based contracts last year expressed interest in doing them. (Famakinwa, 4/7)
CIDRAP:
Polls Show Most Americans Still Prefer Providers To AI For Health Advice
A new poll from the Pew Research Center shows that Americans turn to health care providers the most when it comes to accurate medical advice, with only 36% saying they have used social media or artificial intelligence (AI) chatbots (22%) to gather health information. And a national Ohio State Wexner Medical Center poll of 1,007 adults finds that only 42% are open to AI being used as part of their care, compared with 52% when this survey first ran in 2024. (Soucheray, 4/7)
CIDRAP:
C Difficile Incidence In Hospitals Fell During The COVID-19 Pandemic, New Data Reveal
Global incidence of Clostridioides difficile infection (CDI) in hospitals declined significantly during the COVID-19 pandemic compared with the prepandemic period, Chinese researchers reported late last week in Antimicrobial Resistance & Infection Control. (Dall, 4/7)
