Worcester Business Journal

14 Worcester Business Journal | April 20, 2026 | wbjournal.com BY MICA KANNER-MASCOLO WBJ Staff Writer P rior authorizations cost UMass Memorial Health up to $250 million annual- ly, said Pres- ident and CEO Dr. Eric Dick- son. at might be an underesti- mate, he said. Healthcare leaders across Central Massa- chusetts are looking to Gov. Maura Healey's reforms announced in Jan- uary for relief from insurers' require- ments of proof procedures or medica- tions are necessary before approving coverage. e insurance industry warns their removal could lead to misuse of the medical system and rising costs, and insurers can alleviate some burdens on healthcare providers without government intervention. "We are most excited about the work we are doing today with a few provid- er partners to reduce admin- istrative burden for clinicians," Dr. Sandhya Rao, chief medical officer and senior vice president of Blue Cross Blue Shield of Massachusetts, wrote in an email. Cost of authorization Across the U.S., 92% of medical practices have needed to hire addi- tional administrative staff to handle the increase in prior authorizations, and 97% of surveyed respondents said prior authorizations delayed or denied necessary care, according to a 2026 review published by the e Ameri- can Journal of Medicine. To address these concerns, Healey announced Massachusetts would eliminate prior authorizations for pri- mary care, chronic care, occupational and physical therapy, and certain medications. e Healey Administra- tion hasn't specified a timeline for the reforms' implementation. "We will never make any progress to delivering higher, more affordable health care until we take this head on," said Dickson. e $250 million prior authoriza- tions cost UMass Memorial annu- ally on comes mostly from reduced physician productivity, along with administrative expenses and provider turnover, he said. e expense ac- counts for 2% of the Worcester-based hospital system's $5 billion in annual revenue and represents almost 100% of UMass Memorial's $105.6-million PHOTOS | EDD COTE A $250M cost Insurers say prior authorizations reduce unnecessary care. Hospital leaders say new reforms could ease the administrative burden. As CFO for a rural healthcare system, John Bujak of Heywood Healthcare has staff dedicated to managing prior authorizations at each of its 15 locations. F O C U S HEALTH CARE Dr. Sandhya Rao, chief medical officer for Blue Cross Blue Shield of Massachusetts Dr. Eric Dickson, CEO and president of UMass Memorial Health

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