Administrative complexity adds friction across the healthcare system, creating delays and frustration for members, providers, and employers. Simplifying these processes improves both affordability and experience.
Administrative costs are a significant part of the healthcare system. Research estimates that administrative spending accounts for roughly 15 to 30 percent of total U.S. healthcare costs, highlighting the opportunity to reduce waste and improve efficiency. When processes are overly complicated, employers may face higher costs, providers spend more time on administrative tasks, and members can encounter avoidable obstacles as they seek care.
Prior authorization and other administrative requirements are frequently cited as areas where improvement can make a difference. Physician surveys show that administrative processes can add to clinical workload and, at times, affect the timeliness of care. Thoughtfully reducing unnecessary burden, while maintaining appropriate safeguards, can help create a system that works better for everyone involved.
Premera is investing in technology and smarter workflows to reduce administrative complexity and help people navigate healthcare more efficiently. Artificial intelligence supports this work by automating and accelerating routine, straightforward processes while preserving clinical oversight. Today, about 16 percent of clinical reviews are auto approved, ensuring that we are getting to yes faster. Over time, reducing administrative friction helps support a healthcare system that is both more affordable and easier for people to navigate.
How Premera is responding:
- Using artificial intelligence to accelerate straightforward prior authorization approvals while maintaining clinician review for denials
- Supporting customer service teams with tools that improve speed, consistency, and accuracy
- Modernizing systems and workflows to reduce rework and improve reliability
- Improving provider collaboration tools to increase transparency and reduce back-and-forthÂ
