Why Prior Authorization Needs a Reset: HLTH Podcast with Jeremy Friese, MD

Summary:

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By 2030, prior authorization as we know it will be unrecognizable. The convergence of CMS-0057, WISeR pilots, and nationwide interoperability mandates—paired with breakthroughs in AI—will transform prior authorization from a costly administrative burden into an intelligent, patient-centered clearance process.

‍Jeremy Friese, MD, founder and CEO of Humata Health, joins Sandy Vance to talk about one of the most frustrating problems in healthcare: prior authorization. Luckily, AI may finally be the tool that can fix it. Drawing on his experience as a physician and healthcare executive, Jeremy explains how automation, interoperability, and smarter clinical data workflows can reduce denials, improve efficiency, and help patients get care faster. Their chat explores the changing industry, what still needs to happen, and why the future of prior authorization may look very different by the end of the decade.

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Key topics in this podcast:

• Prior authorization is a major driver of provider burnout and financial loss in healthcare.
• Solving the problem requires both interoperability and advanced clinical intelligence.
• Real-world interoperability is still messy, often involving portals, APIs, and fax.
• AI can now extract the right clinical evidence directly from patient records to improve approvals.
• Automation is cutting physician peer-to-peer reviews by about half.
• Health systems are seeing strong ROI through denial reduction and efficiency gains.
• Getting prior authorization right upfront can recover millions in lost revenue.
• Gold card programs exist, but need better automation to work effectively.
• The future is mostly automated approvals happening behind the scenes.
• By 2030, most prior authorization decisions could be handled by computers, not humans.

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Listen to the full episode now on Spotify or Apple Podcasts.