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Episode 162: Workgroup Voices, The Inner Workings of Prior Authorization

October 29, 2019

Advisor to HHS calls for continued push for efficient and effective sharing of billing and clinical data in order to achieve administrative simplification

WASHINGTON, D.C. — Oct. 29, 2019 — Earlier this month, the Journal of the American Medical Association (JAMA) published an article on Waste in the US Health Care System: Estimated Costs and Potential for Savings. In response to the article’s findings, Jay Eisenstock, Chair, WEDI Board of Directors, today issued the following statement on behalf of the nation’s leading nonprofit authority on the use of health IT to create efficiencies in health care information exchange:

“The findings, as reported in the October 7 JAMA article ‘Waste in the US Health Care System: Estimated Costs and Potential for Savings,’ suggests that a significant portion of our nation’s health care costs can be solved through administration simplification.”

Following the review of 54 unique peer-reviewed publications, government-based reports, and reports from “gray” literature, the article’s authors concluded that waste accounts for approximately 25% of total US health care spending with the single largest component of waste being “administrative complexity” – accounting for $265.6 billion of an estimated $760-$935 billion in waste annually.

“Although we as an industry have come a long way in leveraging technology to enhance electronic data interchange and electronic health records, inefficiencies continue to plague health care, resulting in wasted money and impeding quality of care. However, promising technological advances in this ever-evolving landscape provide significant and hopeful opportunities for improvement.”

Eisenstock continued: “While we have made significant headway, now is the time to accelerate our efforts to address interoperability challenges and to work across the silos to eliminate waste, unnecessary administrative complexities and to simplify the way our systems work together. It’s time to expedite the adoption and implementation of new and updated standards to meet the changing business needs of health care. There are some quick wins like increasing the utilization of electronic payment and establishing a digital identification process to push our efforts towards uninterrupted data exchange. Best practices should be shared across the industry and WEDI is well positioned to lead that effort.”

For more information on WEDI’s industry efforts surrounding electronic data interchange, please visit

About WEDI
WEDI is the leading authority on the use of health IT to improve health care information exchange in order to enhance the quality of care, improve efficiency, and reduce costs of our nation’s health care system. WEDI was formed in 1991 by the Secretary of Health and Human Services and was designated in the 1996 HIPAA legislation as an advisor to HHS. WEDI’s membership includes a broad coalition of organizations, including: hospitals, providers, health plans, vendors, government agencies, consumers, not-for-profit organizations, and standards development organizations. To learn more, visit and connect with us on Twitter and LinkedIn.

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