Matt dives into a specific healthcare topic to help those in the industry, and those outside of it, better understand the market drivers causing today’s healthcare challenges.

Eric Tennant died waiting for approval on a treatment his oncologist prescribed for stage 4 colon cancer. The insurance company eventually approved it. By then, his cancer had progressed beyond the point where the therapy could help.

His widow had to pass a law to prevent the next death.

That sequence tells you everything about who the healthcare system expects to fix its fatal flaws. Not the insurance executives who designed the delay. Not the medical directors who signed off on it. Not the legislators who allowed it. The bereaved.

I call it murder. You can call it bureaucracy if that helps you sleep. But when you build a system that turns time into a weapon against dying patients, you own the outcome.

The insurance industry knows something about human behavior that most patients discover too late: 99% of denied claims are never appealed.

Think about that number. When your doctor says you need a treatment and your insurance company says no, you have a right to challenge that decision. 83% of appeals succeed in overturning the denial, either partially or fully.

But only 1% of patients ever try.

That gap between 1% and 83% is where the profit lives. The insurance company counts on you being too sick, too scared, too exhausted to fight. They weaponize the exact moment when you are most vulnerable and most desperate for speed.

I witnessed this firsthand for seven years, selling to specialty pharmacies and payers. Prior authorization queues operate as financial tools, not clinical ones. The stated purpose is "ensuring appropriate utilization." The operational reality is that friction reduces cost.

Every denial letter buys the payer 7 to 14 days. Every peer-to-peer review request adds another week. Every fax that "wasn't received" further extends the timeline. For a patient with stage 4 colon cancer, those 14 days can move someone from a viable treatment candidate to hospice.

Delay is cheaper than treatment. And a dead patient has zero future claims.

That sounds brutal because it is brutal. But the math works, and the people making that calculation will never sit across from the patient paying for it.

Here's what the research shows: even a four-week delay in cancer treatment increases mortality across surgical, systemic, and radiotherapy treatments for seven different cancers.

Four weeks. That's the median timeframe for a single round of prior authorization with appeal.

The insurance approval process was designed for stable conditions where a few weeks don't alter the clinical trajectory. Apply that same timeline to aggressive cancer, and it becomes an execution protocol. The patient deteriorates while waiting for permission to access the treatment their oncologist already prescribed.

The system knows this. 36% of oncologists report that a patient under their care died due to prior authorization requirements. That's more than one in three cancer doctors who have watched administrative processes kill their patients.

These aren't theoretical harms. There are body counts that no insurance company tracks as a cost of doing business.

I spent 19 years as a patient fighting chronic pain after a spinal cord injury. At 25, my neurologist recommended a spinal cord stimulator to replace the heavy opiates I'd been on for six years. The insurance company denied it. The physician attempted a peer-to-peer review. Denied again.

The reason? My primary pain was in my upper back. The pain in my arms and hands was secondary. Stimulators were approved for primary pain in the extremities. By telling them where my main pain was, I blocked myself from access to treatment.

Choose the dangerous pills for the young guy rather than the more expensive implant.

I still can't get the image out of my mind: people in a room somewhere, laughing, because the system worked exactly as designed.

Eric Tennant's widow did what no insurance executive, no hospital administrator, no elected official did while her husband was alive. She took her grief and converted it into legislation.

We celebrate that as a victory. We should be furious that it was necessary.

The pattern repeats across every disease state. The rare disease parent who builds a foundation because no one has funded the research. The cancer caregiver who launches a nonprofit because navigation services failed their spouse. The patient who starts a podcast because their doctor never explained their options.

The people with the least resources and the most pain become the unpaid labor force for healthcare reform.

And here's what gets me: these families deliver results. They get laws passed. They change formulary decisions. They force congressional hearings. They move the needle in ways that billion-dollar companies with entire government affairs departments cannot or will not.

That should embarrass every executive in this industry.

The system has learned to outsource accountability to grief. It waits for someone to die, then waits for someone who loved them to do the work that should have happened upstream. And it works just well enough that no one with real institutional power feels pressure to change the structure before the next Eric Tennant.

The burden of fixing healthcare should never fall on the bereaved. But until the industry stops treating patient tragedy as an acceptable input cost, families like the Tennants will keep doing the work the system refuses to do for itself.

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I ask companies one question that stops the room every time: "How many patients started your therapy last year, and how many were prescribed it but never started? Do you know why?"

Almost no one can answer the second part.

The gap between prescriptions written and therapies started is where patients like Eric Tennant disappear. The industry calls it "patient attrition" or "prescription abandonment," as if it were a supply chain metric. But each abandoned prescription is a person who needed treatment and didn't receive it.

Some switched therapies. Some gave up. Some got sicker. Some died waiting. And nobody in the company that manufactured their prescribed therapy ever knew it happened.

When I work with organizations through Archo and ELAVAY, we map the patient journey as an operational audit. Where does the patient encounter friction? How long does each friction point last? What's the clinical consequence of that duration? Who inside the organization owns the resolution of each failure point?

You almost always find that nobody owns the resolution. The friction points sit between departments, between vendors, between the company and the payer. The patient floats through that space with no one accountable for their experience.

The companies that actually change are the ones willing to measure what delays cost in human terms and hold themselves accountable to that number, just as they hold themselves accountable to revenue targets.

I've seen it work. A mid-size biotech had its head of commercial operations sit in on a patient listening session I facilitated. A caregiver described calling the hub services line four times in one week to check on the status of a prior authorization. Each time, she got a different person. Each time she had to re-explain her husband's diagnosis. Each time, she was told someone would call back. Nobody did. Her husband started his next cycle late because the authorization came through six days after it should have.

That executive walked out and called an emergency meeting with their hub services vendor that afternoon. Within 90 days, they restructured the entire patient support workflow. The average time to therapy start dropped by 11 days across their patient population.

What broke was the insulation. The layers of abstraction between the people making decisions and the people living with the consequences of those decisions.

If we actually built systems that responded before patients die waiting, three things would have to exist that the current system either refuses to build or hasn't figured out how to operationalize.

First: A real-time accountability loop between the payer decision and the patient outcome.

Right now, a medical director can deny a prior authorization and never learn what happened to the patient afterward. That denial enters a system, generates a letter, and the medical director moves to the next file. There's no mechanism that routes the downstream consequence back to the person who made the call.

If Eric Tennant's denial had triggered an automatic clinical escalation after 72 hours, requiring the denying physician to review updated records and speak directly with the treating oncologist, the delay would collapse. But that system doesn't exist because building it would mean the payer has to confront the human, real-time cost of its own decisions, with a name attached.

Second: A universal patient status registry that every stakeholder in the care continuum can see.

Right now, the patient is the only person carrying the full picture. The oncologist submits the PA. The payer reviews it. The specialty pharmacy waits for approval. The hub services team tracks enrollment. The manufacturer monitors access. None of these systems talk to each other with the patient's urgency as the organizing principle.

If a shared infrastructure existed in which every stakeholder could see that Eric Tennant has been waiting for a therapy his oncologist deemed urgent for 9 days, the social and professional pressure alone would accelerate the process. Transparency eliminates the anonymity that makes delay comfortable.

Third: A patient advocacy function inside every payer organization that reports directly to the CEO with authority to override utilization management decisions on clinical urgency grounds.

Not a grievance department. Not a member services line. A team of clinically trained advocates whose entire job is to identify cases where delay creates irreversible harm and intervene before that harm occurs.

Right now, every payer has people whose job is to slow things down. Almost no one has a job that requires speed when a life depends on it.

Here's what would change immediately if insurance companies carried malpractice liability for denial decisions, the way physicians do for treatment decisions: automated denials would disappear overnight.

Right now, 61% of physicians fear that payers' use of unregulated AI is increasing prior authorization denials. A lawsuit alleges that Cigna denied nearly 300,000 claims, with an average review time of 1.2 seconds. Faster than a human can read a patient's name, let alone their diagnosis.

If malpractice liability attached to denial decisions, no payer would let an algorithm make that call unsupervised. Because the moment a denied patient suffers harm and a plaintiff's attorney can demonstrate that no licensed physician reviewed the case before the denial issued, that payer faces the same standard of care argument every physician in the country already lives under.

You would see the end of bulk algorithmic denials. You would see payers hiring more medical directors, not fewer. You would see peer-to-peer reviews completed within 48 hours, rather than being used as a stalling tactic. And you would see denial rates drop significantly.

The fundamental shift: the payer would have to treat every denial as a clinical decision with clinical consequences, not an administrative action with administrative remedies.

Eric Tennant's oncologist carried malpractice coverage for every treatment decision. The insurance company that blocked that treatment carried none. The oncologist had skin in the game. The payer had a spreadsheet.

Until liability follows the decision rather than the prescription pad, the system will continue to reward the entity that says no while punishing the entity that says this patient needs help now.

After my cervical reconstruction in May 2023, I spent months relearning how to use my body. During that recovery, I talked to other patients. Not as a consultant gathering insights. As someone who just had his neck rebuilt, trying to make sense of what happened. Mind you, this was on my own dime, as insurance didn’t think I needed physical therapy after 14 hours under the knife!

What I heard, over and over, from patients across every disease state: "I had to fight harder to access my care than I fought against my disease."

The patients I talked to weren't defeated. They were angry. They were organized. They were building communities, sharing information, holding each other up, doing it with zero institutional support. The raw material for change already existed in every waiting room, every online support group, every caregiver's kitchen table in the country.

Nobody had organized it into a force that the industry had to respond to.

That's the gap Archo fills. The >10,000 advocacy organizations that now form the backbone of ELAVAY’s database were already doing the work. Patient leaders were already generating the intelligence. Caregivers were already proving that urgency could move faster than bureaucracy.

What didn't exist was a connective layer that translated all that grassroots power into a language pharma boardrooms and payer executives couldn't ignore.

The fight became winnable when I stopped trying to convince companies to do the right thing and started showing them that the right thing was also the smart thing. Because moral arguments bounce off quarterly earnings calls. But when you demonstrate that companies with mature advocacy functions see faster enrollment in clinical trials, stronger real-world evidence generation, better adherence rates, and deeper provider loyalty, finance will sit still for that conversation.

The economics are shifting. The patient voice is getting louder, more organized, and harder to exclude from decision-making. The companies that figure this out early will own the next decade of healthcare. The ones that keep standing still will face a market that has moved past them while they were busy protecting the old model.

I don't need every company to care. I need enough of them to see where the market is going. The rest will follow because they always do.

That's how change scales. Not through moral persuasion. Through competitive pressure built on a foundation that patients and advocates were already laying before anyone in a corner office noticed.

Eric Tennant's widow shouldn't have had to pass a law. But she did. And now we know exactly what the system values: its own survival over patient survival.

The question is whether you're going to wait for the next widow to fix what you already know is broken, or whether you're going to count the bodies you're not counting and build the infrastructure that makes caring operational.

Because the patients are already gone. They're sitting in the gap between prescriptions written and therapies started. And every day you can't name them, describe what happened to them, and explain what you're doing to prevent the next one, you're losing patients you don't know about and will never be held accountable for losing.

Until someone makes you count them.

If you found this article thought-provoking and want to hear more about any given topic, feel free to email Matt directly at [email protected]. We are here to provide insights to the topics that matter to you while advocating for advocacy and the patient voice!

https://www.matttoresco.com