Fixing a System That Forgot Who It’s For

Fixing a System That Forgot Who It’s For

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If you have ever waited for an insurance approval while fear sat heavy in your chest, you know how long a few days can feel. For people facing cancer or another life-changing diagnosis, those days can mean everything. Time is no longer abstract when treatment depends on it.

In today’s world of artificial intelligence, predictive algorithms, and instant communication, it’s hard to believe that access to care can still hinge on something as outdated as a fax. Yet for many patients, the same systems that use AI to decide whether a prior authorization is required also depend on a fax machine to process it. The result is a strange and painful irony: in an era when information moves in seconds, people in need of care can wait days for a piece of paper to clear.

Recent research from the American Society of Clinical Oncology, reported by Medscape and Health Care Un-Covered, shows how far prior authorization has drifted from its purpose. What was once a safeguard to prevent unnecessary costs has become one of the most persistent barriers to care in American medicine. The shift has been slow and quiet, yet deeply harmful. What began as a formality now delays treatment, drains energy, and strains the trust between patients and their providers because of the systems built to prioritize payment over care.

Behind every number in those studies is someone waiting for permission to heal. More than 80 percent of radiation oncologists reported an increase in prior authorization demands in just three years. Nearly all said those requirements affected the quality of care they could deliver. Some even said patients died because approvals came too late. One survey of more than 1,200 cancer patients found that three out of four needed at least one authorization during treatment, and many spent hours or days trying to navigate the process. For people already managing pain, fear, and exhaustion, it became what one researcher called a second job. Most authorizations were eventually granted, but often only after the moment when help would have mattered most.

Clinicians are carrying their own version of that burden. Ninety-one percent of oncologists in the same research said prior authorization has worsened burnout for them and their teams. Many have reassigned skilled staff to manage paperwork instead of patients. Doctors described “peer-to-peer” reviews that felt less like collaboration and more like endurance contests, with little impact on final outcomes. When even basic treatments or anti-nausea medications require approval, the process stops feeling like a safeguard and starts feeling like a wall.

The problem did not begin with bad intent. Prior authorization was created to make care appropriate and affordable. Over time, though, the system grew heavier, more fragmented, and less transparent. In a healthcare landscape shaped by fee-for-service incentives, authorization became routine instead of intentional. Now, new layers of automation and artificial intelligence are being added to make the process faster. The Centers for Medicare and Medicaid Services’ WISeR Model is one of several initiatives designed to modernize prior authorization, but efficiency alone cannot solve a design problem. Technology that speeds up broken systems only reproduces the same inequities at scale. The real issue is not whether a decision is made quickly or by a machine, but who that machine is built to favor.

Artificial intelligence and automation hold enormous potential to reduce administrative waste and return time to patient care, but only if the intent stays rooted in the right place. When the goal shifts from improving outcomes to protecting profit, technology stops serving people and starts reinforcing the same barriers that already exist. The future of healthcare automation should not be about doing the wrong things faster, but about ensuring that every decision—digital or human—remains focused on patients first.

To fix it, healthcare must first remember who it is for. Patients and clinicians want the same thing: timely, thoughtful care that respects both expertise and humanity. What stands in the way isn’t a lack of compassion from those providing care, but a lack of compassion within the systems that govern it. The payer structures meant to manage care have slowly stripped away the empathy that once guided it. Data, workflows, and policies now move faster than the people they’re meant to serve, leaving everyone involved to navigate the gaps.

That is where Hyve Health focuses its work. Hyve was built on a simple belief: in a data-first world, healthcare must stay people-first. Every product and workflow we design begins with that idea. Those insights turn information into understanding and give healthcare teams the clarity to act with confidence.

When healthcare systems can see themselves clearly, they can begin to change. Technology built with empathy doesn’t replace people; it strengthens them. It creates space for care to happen the way it should. Each delay still carries a story about a system that has drifted from its purpose. In the age of artificial intelligence and instant communication, it’s hard to believe that patients and clinicians are still waiting on a fax to be sent. When a patient’s future depends on that kind of delay, it is not just a paperwork issue. It is a human one. Fixing the problems with prior authorization will not come from policy alone or from software alone. It will come from remembering that behind every approval, there is a person waiting to get better.

At Hyve, we believe healthcare should move at the speed of compassion, guided by insight, and grounded in human connection. The process will only heal when it remembers who it was meant to protect. Connect with Hyve and let's talk about how we can help you.

Sources

• American Society of Clinical Oncology, 2025
• Ault, A. (2025, October 10). Prior Auth Hurdles Ramp Up for Patients and Oncologists. Medscape
• Health Care Un-Covered. (2025). Prior Authorization Has Become Standard, When It Shouldn’t.

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