Research-informed report identifies most abrasive administrative processes, laying the foundation for new ‘Harmonizing Healthcare Framework’ to reduce cost, delay, and rework

JACKSONVILLE, Fla.: Availity®, the nation’s largest health information network, today released its first annual Availity Abrasion Index, a research-informed report that measures where administrative friction between health plans and providers is highest - and where the industry has the strongest opportunity to improve.

The report is the first part of Availity’s larger ‘Harmonizing Healthcare Framework,’ which is designed to help health plans and providers assess their own environments and take action to reduce cost, delay, and rework.

Drawing on first-hand interviews and surveys of payer and provider leaders, the report examines six critical administrative processes: eligibility, prior authorization, claims management, medical record attachments, denials, and payment integrity. The research is designed to move beyond anecdotes and identify the specific points where administrative burden, distrust, and operational inefficiency are driving abrasion across the payer-provider relationship.

“The industry often talks about payer-provider abrasion as if it’s a zero-sum dynamic,” said Russ Thomas, CEO of Availity. “What this research shows is that both health plans and provider organizations are caught in the same endless cycle of rework, delay, and unnecessary cost. The real opportunity is to break that cycle by addressing the points where friction is highest to create a better experience for both sides.”

The research found that while abrasion exists across the administrative journey, a few areas emerged as the clearest drivers of preventable rework, administrative cost, and delayed resolution. Specifically, the report found:

• Payers and providers align on where friction is highest. The research found both sides converge most strongly on three high-friction processes-denials, prior authorization, and payment integrity-with payers rating abrasion even higher than providers in most areas studied.
• Denials are the clearest signal of avoidable rework. Denials ranked as the most abrasive process for both providers and payers, and the report found that about 70% of denials are ultimately overturned, adding unnecessary cost and administrative burden for both constituents.
• Prior authorization remains a major source of administrative burden and care delay. Physicians report spending 13 hours a week on prior authorization, and more than 80% of providers say long response times and avoidable denials delay care.
• The broader issue is systemic, not episodic. Across the administrative journey, the report points to the same underlying drivers: lack of standardization, fragmented rules, outdated technology, and misaligned incentives that turn routine processes into repeated cycles of delay, rework, and recoupment.

Despite decades of progress in digitization and connectivity, the research shows that administrative friction persists at massive scale-driven not by a single process or stakeholder, but by systemic complexity, variation in requirements, and misaligned incentives across the healthcare ecosystem.

“Healthcare has made real progress in digitizing these processes, but this research shows that complexity and variation across the system continue to create friction for both providers and health plans,” Thomas said. “No single fix will solve this overnight. But the research makes clear that reducing abrasion starts with better standardization, better data exchange, and earlier visibility into issues before they turn into denials, delays, and rework.”

In addition to the Abrasion Index, the ‘Harmonizing Healthcare Framework’ will help Availity health plan and provider clients make informed business and technology investment decisions with data-rich custom reporting.

Download Availity’s Abrasion Index.

About Availity

Availity empowers payers and providers to deliver transformative patient experiences by enabling the seamless exchange of clinical, administrative, and financial information. As the nation's largest real-time health information network, Availity develops intelligent, automated, and interoperable solutions that foster collaboration and shared value across the healthcare ecosystem. With connections to over 95% of payers, more than 3 million providers, and over 2,000 trading partners, Availity provides mission-critical connectivity to drive the future of healthcare innovation. For more information, including an online demonstration, please visit www.availity.com or call 1.800.AVAILITY (282.4548). Follow us on LinkedIn.

Fonte: Business Wire