What You Should Know
- Availity has launched the 2026 Abrasion Index, a dual-sided research report quantifying administrative friction between U.S. health plans and healthcare providers.
- Denials emerged as the most severe abrasion point, with the report finding that ~70% of denials are ultimately overturned and paid, creating significant administrative “churn”.
- Prior authorization remains a critical burden, with physicians averaging 13 hours per week on the process and 89% reporting it contributes to burnout.
- The research highlights a timing vs. accuracy gap: many administrative failures occur not because of incorrect data, but because correct information arrives too late to prevent downstream damage.
- Payer abrasion is often equal to or higher than provider abrasion, driven by legacy system technical debt and employer-specific plan variation.
The infrastructure of American healthcare administration is currently defined by a “compounding systems problem” where upstream signals fail to hold downstream. Availity, the nation’s largest health information network, has released its inaugural Availity Abrasion Index to provide a measurable baseline for this operational wear. The report argues that what the industry often views as episodic friction is actually systemic abrasion—cumulative operational wear that erodes trust, increases costs, and limits the ability of health systems and plans to scale effectively.
The findings suggest that the most costly failures occur in the “in-between”: the space where information must be interpreted and acted upon across organizational boundaries. This is not merely a story of provider burden; payers report substantial internal overload driven by the complexity of managing fragmented workflows at scale. According to Availity CEO Russ Thomas, the industry is caught in an “endless cycle of rework” that can only be broken by addressing these friction points through shared infrastructure and earlier visibility.
The Structural Reality of Denials and Prior Authorization
Denials represent the most severe source of abrasion identified in the report. Rather than acting as isolated error corrections, denials have become a persistent operating layer of cost control and dispute. The statistic that approximately 70% of denials are eventually overturned highlights a massive coordination failure: billions of dollars are potentially wasted arguing over claims that should have been paid at the initial submission. This “avoidable churn” is often driven by technicalities or timing issues, such as a claim being processed before a benefit update is fully synced.
Similarly, prior authorization continues to be a primary driver of care delays and clinician burnout. While 90% of payers view the process as necessary for cost control, only 47% agree that their own staff have adequate tools to make timely, accurate decisions. This mismatch between intent and execution leads to a reality where 82% of providers agree that initial denials and slow response times directly delay patient care. The report characterizes this not as a lack of goodwill, but as a failure of standardized, API-enabled workflows to keep pace with clinical needs.
Bridging the “Last-Mile” Clinical Data Gap
A significant portion of the administrative burden is tied to clinical data exchange, which remains stubbornly manual even in an EHR-driven world. This “last-mile problem” means that while claims are submitted electronically, the supporting documentation often moves through faxes, PDFs, and mail. This fragmentation leads to matching and routing failures where records arrive but cannot be mapped back to the correct claim, often resulting in “phantom” denials for missing information that the payer may already possess.
The report highlights that 70% of payers find medical records difficult to analyze because they are not in standard formats. This manual sift increases internal costs for plans and forces providers into “proof-seeking” behavior, such as sending records via certified mail to ensure receipt. To move toward what Availity calls “Harmonizing Healthcare,” the industry must shift from reactive, denial-based record acquisition to proactive, data-first workflows where attachments are treated as an integrated part of the claim lifecycle.
Why This Matters
High electronic adoption has masked a collapse in trust because digital transactions are still being invalidated by retroactive data changes. The competitive advantage in 2026 will belong to those who move “left” in the revenue cycle—using neutral, shared infrastructure to validate eligibility and authorization at the point of care, rather than fighting it out in the appeals department six months later.
