
President’s Letter: Remove barriers to timely care between Colorado doctors, patients
President’s Letter: Remove barriers to timely care between Colorado doctors, patients
Wednesday, March 13, 2024
by Omar Mubarak, MD, MBA
As a physician, my first priority is always the health and safety of my patients and their families. As their doctor, I have direct contact and conversations with my patients, the most updated information on their medical needs and surrounding circumstances, and a vested interest in making sure they receive the care they need.
This is why Colorado doctors and patients are coming together to support the streamlining of our state’s prior authorization process to improve access to care and ensure insurance carriers are not delaying life-changing treatment. Health can’t wait.
The facts are clear. Nine out of 10 patients surveyed nationally believe medical decisions should be made between a patient and their provider — not by an insurance carrier. Unfortunately, however, 94 percent of physicians report delays in patient care due to prior authorization challenges, and 80 percent have stated it can even result in patients abandoning treatment. Even more disturbing, 25 percent of doctors reported a delay in care due to a prior authorization issue leading to patient hospitalization, 19 percent reported a life-threatening event, and 9 percent reported an event leading to disability, permanent damage or death. These are risks we shouldn’t and don’t have to take.

I have had countless experiences with this, but you don’t have to take my word for it, nearly every person in Colorado has direct experience with a prior-authorization delay for themselves or a loved one. We also know these experiences are more likely for women, people of color, Coloradans with disabilities and low-income Coloradans who reported a higher percentage of delayed or missed care due to administrative tasks such as prior authorizations. In fact, national pharmacy claims data show among asthma, chronic kidney disease and cardiovascular disease patients covered by commercial insurance, Black and Hispanic patients experience prior-authorization rejections at considerably higher rates than white patients.
There have also been countless national stories about how insurance practices around prior authorization have delayed care, prevented patients from accessing essential treatments, and increased medical costs by the millions. Though insurance carriers are supposed to conduct thorough reviews of medical claims, recent national investigations found one insurance carrier in particular was using an algorithm that denies claims in mere seconds, allowing the insurance company to save money by denying claims and reducing labor costs.
This isn’t a practice used by all insurance carriers, and not all carriers are looking to save money at the expense of patient care. Carriers do a lot of good and serve an important role in our health care system, but this is an example of why we need systematic change.
Health can’t wait, and it’s time for us to remove the bureaucratic and burdensome delays that come between patients and providers, and prevent people from accessing the care they need. There are several reforms that could help streamline access to treatment for families across the state including preventing disruptions in already approved care, like requiring repeated authorizations for patients taking prescription drugs even after they have already been approved for the medication. We can ensure there is continuity of care by extending prior authorizations to last through the course of treatment and protecting patients from disruptions in care by ensuring multiple approvals are not needed as additional treatment is required.
We can also work to make sure there is more transparency in the system and that patients know their rights and likelihood of being approved. This could be done by requiring formularies to be made publicly available to help patients understand their benefits and help patients know what medications are covered and which require prior authorization. Finally, we can incentivize physicians consistently providing quality care and referring patients for medically necessary treatments.
Colorado has looked at improving patient care by streamlining prior authorization requirements in the past, but insurance carriers typically launch a campaign threatening increases in premiums. The reality is these unproven threats don’t tell the whole story. Physicians like myself spend on average two full business days per week dealing with prior-authorization challenges, taking valuable time and resources away from patient care. Eighty-six percent of physicians surveyed said prior authorization resulted in higher utilization of health care resources, including needing additional office visits, emergency room visits, ineffective therapies, and hospitalizations. The truth is delayed care results in more expensive care.
It’s clear rather than seeing patients like physicians do — as people, family members and loved ones — current prior-authorization regulations allow insurance companies to see them as faceless dollar signs.
Health can’t wait. We need lawmakers to work to remove barriers between patients and doctors and streamline our prior-authorization process in Colorado.
Read more about our efforts to reform prior authorization in the legislative report here.