Complementing and ramping up its work to reform insurance practices that adversely affect patient care, the Texas Medical Association has joined a coalition of patient advocates, physicians, and medical groups that aim to put patients front and center in the fight to improve prior authorization delays and denials, as well as overall health plan transparency and accountability.
The Texas Coalition for Patients’ vision statement, available on its website, states the coalition will work to make “health care more transparent and patient-centered by advancing policy reforms that put patients before [insurance] profits and ensure patients receive the insurance benefits they paid for.”
TMA Council on Legislation Chair Zeke Silva, MD, says the new coalition will augment TMA’s current insurance-related advocacy.
“The goal is to establish some focus on shortcomings being experienced by patients,” Dr. Silva said. “The Texas Coalition for Patients creates a forum and a voice to bring patient-specific stories to the forefront. This coalition will allow those patient voices to be heard and those stories to be gathered, and those stories to resonate with lawmakers.”
The organization has aligned around five priorities for the upcoming Texas Legislature session, beginning Jan. 14. Those include:
- Greater transparency related to prior authorization and explanation of benefits;
- A requirement for health plan peer reviewers to sign denial letters;
- A prohibition against health plans relying on third-party vendors to deny care;
- Health plan compliance requirements related to their own charity care and community benefits; and
- Legally requiring health plans to act in their insured patients' best interests when requiring them to use the plan’s pharmacy benefit manager.
The coalition’s formation comes from “long-standing frustrations with insurers and their practices that hurt patients, providers of all types, and physicians,” added TMA Director of Public Affairs Ben Wright. “There's this collective group that have each experienced their own struggles who can all agree that insurers have gone too far. [Health plan] practices are increasing the cost of care, delaying necessary patient care, and causing frustration and headaches for everyone receiving or providing care. Frustration is at an all-time high.”
The coalition highlights a 2023 physician survey conducted by the American Medical Association reporting the prior authorization process had a negative impact on patient clinical outcomes according to 93% of physicians surveyed; about a quarter of physicians said the practice led to serious adverse outcomes for patients, including death, hospitalization, or permanent injury.
“Through [TMA’s] participation in this coalition, that's really what [physicians] can do best – elevate the voices of patients who are affected by all of these things,” Mr. Wright said.
Other participating organizations include the Texas Association of Neurological Surgeons, the Texas College of Emergency Physicians, the Texas Hospital Association, the Texas Orthopaedic Association, the Texas Organization of Rural & Community Hospitals, The Livestrong Foundation, and National Alliance on Mental Illness Texas.
Learn more about TMA’s state advocacy, and review the latest round of physician testimony ahead of the 2025 session.
Phil West
Associate Editor
(512) 370-1394
phil.west[at]texmed[dot]org
Phil West is a writer and editor whose publications include the Los Angeles Times, Seattle Times, Austin American-Statesman, and San Antonio Express-News. He earned a BA in journalism from the University of Washington and an MFA from the University of Texas at Austin’s James A. Michener Center for Writers. He lives in Austin with his wife, children, and a trio of free-spirited dogs.