Every December brings new opportunities to make lists, whether they’re for gifts, holiday cards or resolutions for the new year.For physicians like me, however, there’s also the ever-present policy wish list filled with ways to improve patient care and cut through the red tape that limits our capacity to help more Oklahomans.As we approach a new year — and a new legislative session — it’s imperative to explore how legislators have the power to improve health care in 2025 and beyond.In speaking with my patients and colleagues, insurance-related issues were among their top concerns, so I would be remiss if I didn’t include several of those in my 2025 wish list.First, Oklahoma should limit the use of artificial intelligence and automated systems to review patient procedures and treatments. Picture this: you or a loved one’s care is denied or delayed simply because a computer model deemed it “not medically necessary.” It’s infuriating, and we must insist on inserting humanity back into the claims process by ensuring that licensed physicians, not a computer, review all insurance prior authorizations.Another insurance-related concern was the practice of payment “clawbacks.” Under current Oklahoma law, an insurance company can approve a medical procedure or treatment and then has up to 18 months to change its mind or “claw back” the provider payment. This practice is not only confusing but costly, ultimately leaving patients with medical bills they thought were covered. Rolling back this practice gives patients much-needed peace of mind.The new Medicaid managed care reimbursement system — now operated by private sector cost-cutting insurers — is cumbersome and painfully slow. It leaves patients in limbo while physicians wait for payments, forcing some to take out loans as a stopgap so they can continue operations and don’t have to delay patient treatments. Greenlighting much-needed improvements to this process would allow providers to focus on what they do best: caring for patients.Drug formularies and prior authorization requirements are notoriously inconsistent across Medicaid-managed care companies, causing headaches for physicians when writing prescriptions. By cracking down on this, legislators can help eliminate confusion and reduce administrative burden so patients can receive quality care, regardless of which carrier they choose.I sincerely wish that every Oklahoman receives the care they deserve without jumping through endless hoops. By advocating for these changes, I hope to set us on a path toward a health care system that aligns with what is right for patients ...
