Case Study · Latent × UNC Health · 2026
How UNC Health scaled medication access +45% without adding headcount
Enterprise medication access
Prior authorizations a year
A subset of ~50,000 referrals
First-pass approval rate
On initial submission
Year-over-year volume growth
Absorbed without proportional headcount
Every patient asking about a new medication has the same question.
“Can I get my medication, and can I get it in time at a cost I can afford?”
Dr. Robert Granko
System Vice President, Pharmacy Business Operations at UNC Health
That question lands on pharmacy teams every single day. At UNC Health, the team manages nearly 50,000 referrals a year, including 40,000 prior authorizations, with a 74% first-pass approval rate. This year, with AI embedded in the workflow, the team absorbed more than 45% year-over-year volume growth without proportional headcount increases.
Before deploying any technology, Dr. Robert Granko, System Vice President, Pharmacy Business Operations at UNC Health, asked the more important question. Not how do we keep up with volume, but what should this work actually look like?
That reframe is harder than it sounds. Most health systems respond to rising PA volume the way they respond to most operational pressure: add people, add hours, ask the team to do more. It works until it doesn’t. For many pharmacy teams, it already isn’t working.
“We didn’t deploy AI into existing processes unchanged. We first and have continually asked, while challenging existing held beliefs, what should this work look like if the goal is timely, reliable patient access?
Dr. Robert Granko
System Vice President, Pharmacy Business Operations at UNC Health
02 · One Journey
Six functions. One patient journey.
The work at UNC has been about scale and visibility. UNC’s central pharmacy team sits at the core of how UNC coordinates medication access across prior authorization, financial assistance, specialty pharmacy, home infusion, ambulatory care, and 340B. These are not separate functions in Granko’s view. From a patient’s perspective, they are all part of the same journey.
One coordinated view. UNC Health uses Latent Health’s Enterprise Pharmacy Intelligence Platform, with AI embedded in the workflow, supporting prior authorization across specialty, infusion, and ambulatory care.
The Fragmentation
When they tried to standardize, the fragmentation showed.
When UNC expanded into infusion prior authorizations, what they found was revealing. Different submission methods, portals, fax, and EHR workflows had created a fragmented picture around the same patient.
Duplicated work. Inconsistent tracking. Variable turnaround times. The fragmentation was not fully visible until they tried to standardize across it.
Three methods, one patient. The same infusion authorization arrived by portal, by fax, and through the EHR, each building its own record. Standardized across those methods, the three resolve into one tracked view.
03 · The Table
A redesign this size doesn’t happen inside one department.
The data told a clear story. Even with strong performance and significant efficiency gains from AI, the current workflow design could not meet total system demand without change.
That gap did not just surface a capacity problem. It brought leaders to the table. Pharmacy, providers, nursing, revenue cycle, IT, and strategy sat together in a two-day Express Workout to define what a future-state model should look like.
Six seats, one table. Pharmacy, providers, nursing, revenue cycle, IT, and strategy sat together in a two-day Express Workout to define the future-state model.
“Our data didn’t just highlight a capacity issue. It’s helping us align leaders around a shared responsibility to patient access and re-imagine new possibilities.
Dr. Robert Granko
System Vice President, Pharmacy Business Operations at UNC Health
The Capacity
When the burden lifts, capacity flows to patients.
UNC is a large academic medical center forecasting 45%+ volume growth in its first year of this work. For all the scale it operates at, the conclusion Granko reached translates well beyond any single system. These solutions, he says, are labor complements rather than labor substitutes. The value is not in doing the work faster. It is in what teams can do with the capacity they get back.
When the administrative burden lifts, capacity flows to patients. At UNC, that means faster outreach, proactive follow-up on stalled authorizations, and stronger financial navigation support.
- 01 Faster outreach
- 02 Proactive follow-up on stalled authorizations
- 03 Stronger financial navigation support
04 · The Result at Scale
+45% year-over-year volume growth, absorbed without proportional headcount increases.
Year-over-year volume growth in the first year of this work. Reported by UNC Health.
The Standard
Speed was never the goal.
The standard Granko holds is simple.
“Efficiency gains only matter if patients and our providers feel them.
Dr. Robert Granko
System Vice President, Pharmacy Business Operations at UNC Health
Not review time in isolation. Not FTE counts.
Whether the patient starts therapy this week or waits another two.
Whether the provider gets a clear answer or another callback.
Whether the pharmacy team ends the day having done the work they actually want to do.
Still Building
UNC is still building. Granko is direct that expanding into infusions is early and there is more work ahead.
The question Granko has moved past is whether to redesign. That decision has been made.
The real debate is no longer whether pharmacy operations need redesign. The more important question is how much better pharmacy can perform when workflow, technology, and operating models are aligned to support the team and patients.
UNC Health uses Latent Health’s Enterprise Pharmacy Intelligence Platform, with AI embedded in the workflow, supporting prior authorization across specialty, infusion, and ambulatory care, so the capacity the team gets back flows to patients.
Adapted from the original report in Becker’s Hospital Review.