Humana is ramping up its efforts to reform the prior authorization process with a set of new policies that will reduce volumes for providers, speed up decisions, and increase transparency.
Becker’s sat down with Caraline Coats, senior vice president for clinical strategy and operations at Humana, to discuss the company’s latest commitments.
Question: How are you thinking about balancing the need for reducing administrative burdens while maintaining financial sustainability?
Caraline Coats: That is the crux of all of this, striking that balance. The role of prior authorization can provide a lot of safety and efficacy for our members, particularly when we focus on high-cost, high-acuity procedures and processes where we can provide safety and a procedural framework. However, we also need to balance this for more routine services, which can become a burden for providers or potentially delay access to care. It’s a continuous balance that evolves depending on the needs of our populations, our members, and our providers. We continually assess the prior authorization process to ensure we strike that balance, providing protection for our members while reducing the burden on providers.
As procedures and medicine evolve, I anticipate a continuous evolution of the prior authorization list and processes throughout the industry.
Q: How do you plan to measure and ensure that physicians consistently meet the criteria for waiving prior authorization under the new gold carding program?
CC: The gold carding program is new for us. We started the pilot in 2025 with a sizable population of providers and members. We’re optimistic about the results and are looking forward to scaling it to other high-quality providers across the country in 2026. We’re targeting providers with a proven record of delivering high-quality healthcare and consistent outcomes. We believe the gold carding process, when applied to the right providers with those quality outcomes, can really reduce the time and resources providers spend on prior authorization, cutting down on administrative costs.
Q: A 2022 AHIP survey of 26 insurers on gold carding showed that a third of respondents say these programs are administratively difficult to implement and 20% said they reduced care quality. How do you plan to navigate these possible challenges?
CC: It’s a continuous evolution. A big part of it is listening to our providers and members. We gather a lot of survey data and assess insights from that to help us stay ahead of the curve and be leaders in this space, striking that right balance. We aim to reduce some of the procedural burden while maintaining efficacy. This involves a lot of listening and investing in technology where we can gain more access to electronic information and increase interoperability, which, in turn, increases transparency and timeliness.
Q: How do you think the reporting of prior authorization metrics will impact the broader healthcare industry, and what do you hope to achieve by providing this level of visibility?
CC: It’s all about transparency and providing information that can sometimes be confusing for both the consumer and the provider. We’re working to expedite the implementation of new federal transparency requirements, which I believe will ease the complexity of how we consume this information, make it more consumer-centric, and easier for the provider. It will be a work in progress, but I believe it’s moving in the right direction.
