CommonSpirit Sets 5 Tests for Payer Prior Auth Reform

CommonSpirit Health is pushing back on how prior authorization reform gets measured. In 2025, insurers pledged to scale back and simplify prior authorization as they align with the 2024 Interoperability and Prior Authorization and Medicare Advantage final rules, according to Becker's Hospital Review. But CommonSpirit argues the newly required insurer data lacks context. Aggregated numbers, for example, do not show how often denials are overturned on appeal or which services carry the heaviest administrative burden.

To hold payers accountable, the system laid out five targets it will use to judge whether reforms are genuine rather than cosmetic. It also reported a milestone in its prior authorization work with Humana, a sign that direct provider-payer agreements can move faster than broad industry commitments.

The backdrop is a federal effort to standardize and speed prior authorization decisions through interoperable data exchange. CommonSpirit's stance is a reminder that reported progress and real relief for clinicians and patients are not the same thing.