Former AMA President Dr. Jesse Ehrenfeld Meets with WISHIN

According to an American Medical Association survey, 9 of 10 physicians say prior authorization harms patient outcomes. Immediate Past President of the American Medical Association Dr. Jesse Ehrenfeld, MD, MPH, FAMIA, FASA, is optimistic the new prior authorization rules will be beneficial for patient care. In a conversation with Ehrenfeld, WISHIN CEO Steve Rottmann spoke about WISHIN’s ability to assist providers and payors to meet the new prior authorization requirements. “WISHIN is facilitating the exchange of data between providers and payors,” Rottmann said. “WISHIN has the legal agreements and established data governance amongst providers and payors to increase efficiencies and reduce administrative burden that exists today related to prior authorizations and other use cases.”

The Centers for Medicare and Medicaid Services (CMS) says the goal of the new rules is to improve the electronic exchange of health information and prior authorization processes. Beginning in 2026, government-regulated health care plans will be required to shorten the time for prior authorization decisions. The plans must offer electronic prior authorization which integrates with electronic health records.

“Increasing efficiency and enabling health care data to flow freely and securely between patients, providers and payors, and streamlining prior authorization processes supports better health outcomes and a better health care experience for all,” said former CMS Administrator Chiquita Brooks-LaSure in a press release.

Ehrenfeld, who is Senior Associate Dean and Professor of Anesthesiology and Director of the Advancing a Healthier Wisconsin Endowment at the Medical College of Wisconsin, says the new rules will cut delays for patient care, electronically streamline the process for all physicians, and save physician practices an estimated $15 billion over ten years.

Rottmann told Ehrenfeld WISHIN already cuts delays for patient care and streamlines the process for physicians. “Given WISHIN is a reciprocal statewide network, payors are required to contribute data, and prior authorization determinations will be at the top of the list in the near future,” Rottmann said. “WISHIN can facilitate this exchange through the network.”