EP264: How Prior Auths Collide With Trust, With Ron Wince, CEO of Myndshft
Episode Description
In this episode, Stacey Richter talks with Ron Wince, CEO of Myndshft, about how prior authorizations collide with trust between payers and providers.
WHAT YOU'LL LEARN
✅ Why payers put prior authorizations in place, and the three reasons behind them: cost, medical necessity, and compliance
✅ How the prior authorization system can fail both patients and payers
✅ The toll prior authorizations take on providers and patients alike
✅ What "gold carding" means and how it fits into the prior authorization landscape
✅ How technology like Myndshft's is trying to solve the "chasm of trust" at the center of prior auth
WHY THIS MATTERS
Ron Wince describes a vicious cycle: payers don't trust providers to deliver only appropriate care, so they impose prior authorization requirements; providers then learn to game those requirements to get patients care faster, which triggers even more arduous processes that catch good and bad actors alike in the same net. The result is moral injury and burnout for clinicians and painstaking delays for patients. Wince argues that technology at the intersection of AI and blockchain could help close this chasm of trust, but only if it addresses the underlying incentives driving the standoff between payers and providers.
MENTIONED IN THIS EPISODE
=== LINKS ===
🔗 Show Notes with all mentioned links: Episode Page
🔗 Healthcare Industry Acronyms and Terms
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00:00 Introduction.
01:29 What is a prior authorization?
02:45 The three reasons payers put prior authorization in place.
02:49 Cost, medical necessity, and compliance.
04:24 EP200 with Stacey Worthy.
05:15 "Clinicians are really managing clinicians in a lot of ways."
05:41 Why the prior authorizations system sometimes fails patients and payers.
08:13 Surprise care—can it be avoided?
09:53 The impact on providers.
14:52 The impact on patients.
16:46 Specialty pharmacy and prior authorizations.
18:43 Shkreli Awards (EP260).
19:25 The most complex prior authorizations.
21:03 E-prior authorizations.
24:19 Gold carding and what that is within prior authorizations.
28:08 The "chasm of trust."
29:11 Myndshft and its goal to solve prior authorization issues.
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