Moving Medicine How are states taking up key health care issues? Part I
Jun 16, 2025
In this insightful discussion, Emily Carroll, a senior attorney specializing in payer issues, Kim Horvath, who tackles scope-of-practice policies, and Daniel Blaney-Cohn, an advocate for physician wellness, share key insights on state legislative priorities for 2025. They explore the rising trend of scope expansion bills and the AMA’s efforts to combat them. Emily highlights innovations in prior authorization processes, including the impact of AI, while Daniel discusses tackling stigma surrounding mental health in licensing practices. It's a compelling look at the future of healthcare advocacy!
AI Snips
Chapters
Transcript
Episode notes
Push For Prior Authorization Data
- Push states to collect and publish prior authorization data for transparency and targeted reform.
- Have insurers report approvals, denials, and wait times to regulators for statewide analysis.
Demand Qualified Reviewers
- Require insurer reviewers to be licensed physicians in the same specialty and state for medical necessity denials.
- Insist that a physician, not just an AI, make final denial decisions.
Combine Automation With Limits
- Use automation plus limits to speed prior authorization and reduce unnecessary volume.
- Push for 24-hour urgent and 48-hour non-urgent decision windows, reviewer qualifications, and gold carding exemptions.