Data on Managed Care Reported by Researchers at University of Georgia (Health System Integration and Prior Authorization in Medicare Advantage): Managed Care

2026 JUN 12 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Investigators publish new report on Managed Care. According to news reporting originating in Athens, Georgia, by NewsRx editors, the research stated, “To examine whether Medicare Advantage (MA) plans affiliated with health systems adopt less restrictive prior authorization (PA) policies than non-affiliated plans. We conducted a descriptive analysis comparing PA policies between system-affiliated and unaffiliated MA plans from 2016 to 2023.”

The news reporters obtained a quote from the research from the University of Georgia, “Using Plan Benefit Package data, we constructed enrollment-weighted measures of PA intensity based on the share of service categories requiring PA. We assessed robustness using alternative measures, including service-specific PA requirements, service mix-adjusted overall intensity, and measures without enrollment weights, and also examined results by plan type. Analyses included 6480 MA health maintenance organization and preferred provider organization plans operating during the study period. Enrollees in system-affiliated MA plans faced fewer PA requirements than those in unaffiliated plans. In 2023, the difference was 31 percentage points (pp): among 23 service categories, enrollees in affiliated plans were enrolled in plans that required PA for 51% of categories, compared with 82% in unaffiliated plans. Differences were especially pronounced for behavioral and mental health services and dialysis (52-59 pp).”

According to the news reporters, the research concluded: “System affiliation is associated with less restrictive PA policies in MA, highlighting organizational structure as an important dimension of utilization management.”

This research has been peer-reviewed.

For more information on this research see: Health System Integration and Prior Authorization in Medicare Advantage. Health Services Research, 2026;61(3). Health Services Research can be contacted at: Wiley, 111 River St, Hoboken 07030-5774, NJ, USA. (Wiley-Blackwell - http://www.wiley.com/; Health Services Research - http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1475-6773)

Our news correspondents report that additional information may be obtained by contacting Eunhae Shin, Dept. of Health Policy and Management, University of Georgia, Athens, Georgia, United States.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.1111/1475-6773.70137. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

The publisher of the journal Health Services Research can be contacted at: Wiley, 111 River St, Hoboken 07030-5774, NJ, USA.

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