Several healthcare IT vendors unveiled new offerings over the past week that help healthcare systems improve patient access, address provider burdens and drive cost optimization.
Oracle Health said Monday it wants to help tame providers’ administrative challenges by replacing manual processes with cloud-based automated claims processing, while Luma Health on Tuesday released machine learning and natural language processing enhancements to transform workflows.
Also this past week, athenahealth said it is looking to improve holistic care delivery with new behavioral health integration into its cloud-based electronic health records. And Clarify Health hopes to promote greater transparency and build trust by providing immediate access to performance measures and predictive analytics that span cost, quality and utilization.
Oracle uses FHIR
Oracle said the general availability of automated data exchange between healthcare providers and payers will change the way authorizations are handled.
“The healthcare industry has long been plagued by costly, time-consuming and outdated claims processing that results in billions in unnecessary costs each year, and ultimately a strained relationship between providers and payers,” said Seema Verma, executive vice president and general manager of Oracle Health and Life Sciences, said a statement.
About 70% of authorizations are handled by phone or fax, with payers and providers sharing about 25% of reimbursement-related documents, Oracle said.
The new clinical data exchange platform could help alleviate the burden of administrative tasks and move providers and payers away from these manual processes by sending medical records through a secure, centralized network. It also helps providers streamline responses to payer data requests and ease staffing burdens, said Kent Hoyos, vice president and chief information officer at Pomona Valley Hospital Medical Center.
Providers select which data they want to make accessible to their payer partners on the platform and can review selected clinical data with chosen payers to confirm exactly what data was received, Oracle said. Payers retrieve clinical data via FHIR queries or bulk processing in an industry-standard format without the need for additional point-to-point connections.
Faster responses from payers and faster reimbursement of claims could also expedite the speed of patient care.
“Automating the process will help expedite the approval of necessary clinical services for patients and the processing of payments and shorten the wait time for our patients to receive the care they need,” Hoyos said in a statement.
Luma automates with genAI
San Francisco-based Luma Health on Tuesday announced two new artificial intelligence products for its patient success platform. The multi-model generative AI called Spark can be used to address common operational challenges for healthcare systems, including high call volume and manual fax processing.
“Our vision is to use this latest breakthrough technology to solve persistent challenges at scale, and now the technology is equipped to help us deliver a next-generation patient experience,” said Aditya Bansod, co-founder and chief technical officer of Luma. in a statement.
“Health systems are scrambling more than ever to serve their patients with fewer staff and resources, and they don’t have time to waste on AI solutions that offer superficial EHR integration or create more overhead,” added Luma’s co-founder and CEO Adnan Iqbal to it. .
“That’s why we focused Spark on the most common challenges we hear in healthcare systems: high call volume, backlogged referrals, lost revenue, and not enough staff to handle it all manually.”
Interwoven into the company’s patient success platform, Spark has bi-directional integration with leading EHRs, including Oracle Health, Epic, eClinicalWorks, Meditech, athenahealth, NextGen and Greenway Health, according to Luma.
The first two Spark-compatible tools automate fax processing – Luma’s Fax Transform – and provide a patient-centric voice AI concierge – Luma’s Navigator.
Healthcare providers can use Luma’s Fax Transform to automatically parse structured data from faxes, including referrals, prescription refills and more, to verify information, then automatically create the referral in a healthcare system’s EHR.
DENT Neurologic Institute said it is experiencing three times faster fax processing and 70% time savings on fax workflows with the new tool.
“We receive a lot of faxes – more than 500 per day across the organization – and it is simply impossible to keep track of this manually,” Emily Smythe, the institute’s quality and analytics manager, said in a statement.
“Processing a single fax can take up to five minutes. Fax Transform completely automates this so that archiving a fax takes ten seconds or less.”
The University of Arkansas for Medical Sciences adopted Luma’s AI concierge and, within a month, saved 98 manual call center staff hours, automated 95% of phone calls, processed 1,200 cancellations without any human interaction and more, according to the announcement.
“The team spent three hours every day listening to patients’ voicemails and then going in to cancel appointments,” said Michelle Winfield-Hanrahan, RN, UAMS’ Chief Clinical Access Officer and Vice Chancellor for Access, in a statement. “Our results were very positive and really exceeded what I expected.”
Athenahealth integrates behavioral health
To enable personalized care, EHR company athenahealth has launched athenaOne for Behavioral Health. The suite includes treatment plans, group therapy options, customized session documentation, a privacy toolkit, patient engagement tools and more, Athena announced last week.
“Behavioral healthcare providers strive to deliver comprehensive, meaningful care, but often face a perfect storm of challenges that can get in the way of delivering care that achieves desired health outcomes,” said Chad Dodd, vice president of product management at the company. a statement.
The new certified platform also includes tools for mental health practices and revenue cycle management with workflows and embedded services for coordinated care.
By integrating behavioral health and primary care into a single solution that supports various care models, including outpatient behavioral health practices, intensive outpatient programs, and partial hospitalization programs, providers can access relevant patient data from across the healthcare ecosystem at a glance.
Patients can also schedule appointments and communicate with healthcare providers and staff on the new platform.
Clarify launches AI for performance monitoring
Because traditional analytics falls short in delivering actionable information that optimizes provider networks and effectively manages costs, Clarify Health said it is deploying its Clara IQ artificial intelligence to enable health plans to drive value.
“Our industry continues to struggle to deliver more effective care for every dollar spent,” said Todd Gottula, the company’s founder and president, in a statement. “We have invested significantly in developing fully integrated measures and benchmarks. This allows health plans to understand provider performance, utilization patterns, referrals and clinical populations at a granular level.”
The new Performance IQ Suite, powered by the Clarify Atlas Platform, provides instant access to performance measures and detailed analytics while also allowing providers to understand how they are evaluated.
Health plans can use the insights to optimize provider performance, assess competitive networks, direct referrals to high-performing specialists based on comprehensive cost and quality metrics, reduce unnecessary spending and more, according to Clarify.
Andrea Fox is editor-in-chief of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.