RFK/Payer Industry Prior Authorization Expansion Will Stress Core/Fraud Engines

This IDC Market Note summarizes the landmark agreement with the nation's largest health insurers to tackle the number 1 healthcare problem plaguing hundreds of millions of Americans: prior authorization. It discusses the agreement and the impact for health insurers on all lines of business. "Prior authorization, mandated again in 2025 by CMS to be more efficient and transparent, is a priority area of payer spend. Vendors are coming from many avenues to offer solutions for both regulatory compliance and comprehensive care and utilization management. The space is complex, and the market is hot because the mandates and the industry's reputation risk keep growing." - Jeff Rivkin, research director, Payer IT Strategies at IDC