A patient can receive the right diagnosis, have an appropriate treatment recommended and still face significant obstacles before receiving care.
To Dr. Tamiko Foster and Dr. Aparna Ahuja, those obstacles reflect a larger problem within the health care system. Treatment delays often originate in the policies, research and administrative processes that shape clinical decisions long before patients enter an examination room.
Speaking at the 2026 HealthStack Conference, the physician executives challenged health professionals to look beyond the paperwork associated with insurance approvals and examine the systems determining which patients receive timely treatment.
Foster, a former chief medical officer and founder of 2 E.D.I.F.Y., brought a health policy and clinical operations perspective to the discussion. Ahuja, founder of AJA LifeSciences Advisory, focused on how gaps in clinical research can influence treatment guidelines and insurance coverage decisions.
Their message was that making health care more efficient will accomplish little if the underlying processes continue to disadvantage certain patients.
When Insurance Requirements Become Barriers To Care
Prior authorization emerged as one of the clearest examples of how administrative processes can affect clinical outcomes.
Although intended to ensure appropriate treatment and manage health care spending, the requirements can also delay necessary care, increase workloads and contribute to patients abandoning treatment.
The speakers pointed to the American Medical Association’s 2025 physician survey, which found that 95% of physicians reported prior authorization-related care delays. Another 79% said the requirements sometimes resulted in patients abandoning treatment, while physician practices spent an average of 13 hours weekly managing authorization-related work.
Foster acknowledged that insurers have legitimate reasons to review treatment requests, including ensuring that care is appropriate and financially responsible. The concern, however, is whether those requirements create unnecessary obstacles between patients and their physicians.
The consequences can be particularly significant for providers serving low-income communities.
A presentation chart showed Medicaid physician reimbursement at approximately 75% of Medicare rates, compared with commercial medical services payments averaging 196% of Medicare rates. Although the figures represent different payment measures, they highlighted the financial pressures facing providers who care for patients covered by public insurance.
Foster also connected Medicaid funding decisions to the stability of care for vulnerable populations.
“Underfunding Medicaid is a policy choice,” she said. “It sends a clear message that serving the most vulnerable is financially unstable.”
When reimbursement pressures intersect with eligibility interruptions, provider shortages and authorization requirements, patients can face multiple barriers to receiving recommended treatment.
For clinicians, those barriers can mean spending additional time navigating coverage requirements while patients wait for care.
The Problem Begins Before Insurance Approval
Ahuja pushed the discussion further upstream, examining how the evidence used to develop clinical guidelines can influence whether patients receive treatment.
Clinical trials do not always adequately represent the racial, socioeconomic and clinical diversity of the populations that eventually receive medical care. When research findings inform treatment guidelines, those guidelines can become the basis for insurers’ utilization management criteria, including prior authorization requirements.
The result is a chain of decisions in which gaps in clinical evidence can influence coverage restrictions and patients’ access to treatment. One presentation slide summarized the problem.
“The delay is downstream,” it read. “The bias is upstream.”
For patients whose characteristics or medical conditions differ from those represented in clinical trials, restrictive coverage criteria may require additional documentation, appeals or unsuccessful attempts with alternative treatments before approval.
The concern is not simply whether an insurer processes a request quickly, but whether the criteria used to evaluate that request reflect the patient receiving care. That distinction has implications for physicians, researchers and health system leaders who rely on evidence-based guidelines to make clinical and coverage decisions. It also raises questions about whether emerging technologies can improve access without reproducing the same disparities.
Making Care Faster Without Reinforcing Inequity
Artificial intelligence and digital tools could help reduce some of the administrative burdens associated with treatment approvals.
The speakers identified AI-assisted prior authorization submissions, electronic health record-integrated decision support, real-time eligibility verification and predictive analytics as opportunities to streamline existing processes.
Gold-carding programs, which exempt qualifying providers from certain authorization requirements, offer another approach to reducing administrative delays. But, the potential benefits of automation come with an important limitation.
“Automating an inequitable process scales the inequity,” one presentation slide warned.
If an automated system relies on coverage criteria derived from clinical research that does not adequately represent diverse patients, it could reproduce inequitable decisions more quickly rather than improve access. For hospitals and technology developers, the discussion underscored the importance of examining the evidence and policies behind automated decisions before measuring success solely through processing speed.
Where Can Health Professionals Address Concerns
The speakers offered three areas where health professionals could begin addressing those concerns.
Clinicians and researchers can advocate for more diverse clinical trial enrollment, helping ensure that treatment guidelines reflect the populations they serve. Health executives and insurers can evaluate prior authorization criteria across patient groups to identify requirements that may disproportionately restrict access. Technology and data teams can incorporate real-world evidence from diverse patient registries to help address gaps between clinical trials and everyday patient populations.
Together, those approaches shift the conversation from reducing administrative delays to improving the fairness of the decisions that determine access to care.
For clinicians, that means looking beyond individual denials, documenting recurring authorization barriers and questioning whether coverage requirements adequately account for patients’ clinical circumstances.
The goal is not simply to move patients through the same system more quickly, but to ensure the system makes appropriate treatment accessible in the first place.
“The fix isn’t just faster — it’s fairer,” the slides concluded.
