Last week, several healthcare IT vendors unveiled novel offerings that facilitate healthcare systems improve access to patients, address provider burdens and ensure cost optimization.
Oracle Health said on Monday it wants to facilitate providers overcome administrative challenges by replacing manual processes with automated claims processing in the cloud, while on Tuesday Luma Health released improvements in machine learning and natural language processing to transform workflows.
Also last week, athenahealth said it aims to improve the delivery of holistic care with a novel integration of behavioral health with cloud-based electronic health records. Clarify Health hopes to enhance transparency and build trust by offering direct access to performance metrics and predictive analytics across cost, quality and utilization.
Oracle uses FHIR
Oracle says the general availability of automated data exchange between healthcare providers and payers will change the way authorizations are handled.
“Health care has long struggled with costly, time-consuming and outdated claims processing, which results in billions in unnecessary charges each year and ultimately strained relationships between providers and payers,” Seema Verma, executive vice president and general manager, Oracle Health and Life Sciences, wrote in statement.
According to Oracle, about 70% of authorizations are done by phone or fax, and payers and providers exchange about 25% of reimbursement-related documents.
A novel clinical data exchange platform can facilitate reduce administrative burdens and move providers and payers away from manual processes by transmitting medical records through a secure, centralized network. It also helps providers streamline responses to payer data requests and reduce staff workload, according to Kent Hoyos, vice president and CIO at Pomona Valley Hospital Medical Center.
According to Oracle, providers choose what data they share on the platform with their payment partners and can audit selected clinical data with selected payers to confirm exactly what data was received. 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 payer responses and reimbursement can also speed up patient care.
“Automating the process will help speed up approval of necessary clinical services for patients, as well as payment processing, and reduce the time our patients wait to receive the care they need,” Hoyos said in a statement.
Luma automates with genAI
San Francisco-based Luma Health announced two novel AI-powered products for its patient success platform on Tuesday. A multi-model generative AI called Spark can be used to address common operational challenges of healthcare systems, including high call volumes and manual fax processing.
“Our vision is to use this cutting-edge, breakthrough technology to solve persistent problems on a massive scale, and now the technology is equipped to help us deliver the next generation of patient experiences,” Aditya Bansod, co-founder and CTO of Luma, said in a statement.
“Health care systems are doing 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 shallow EHR integration or result in higher overhead costs,” added co-founder and CEO Luma Adnan Iqbal .
“That’s why we focused on the most common challenges we hear from health systems: high call volume, delayed referrals, lost revenue, and not enough staff to handle it all manually.”
Woven into the patient success platform, Spark provides two-way integration with leading healthcare specialists, including Oracle Health, Epic, eClinicalWorks, Meditech, athenahealth, NextGen and Greenway Health, Luma said.
The first two Spark-enabled tools automate fax processing – Luma Fax Transform – and provide patient-centric AI voice support – Luma Navigator.
Provider staff can operate Luma’s Fax Transform feature to automatically analyze structured fax data, including referrals, prescription refills and more, to validate the information, and then the referral is automatically created in the health system’s EHR.
DENT Neurology Institute said it is experiencing three times faster fax processing and a 70% time savings in its fax workflow with the novel tool.
“We receive a lot of faxes – over 500 a day across the organization – and it’s simply impossible to keep up with them manually,” Emily Smythe, the institute’s manager of quality and analytics, said in a statement.
“A single fax can take up to five minutes to process. Fax Transform completely automates it, so sending a fax takes 10 seconds or less.”
The University of Arkansas for Medical Sciences implemented Luma’s AI concierge service and, within a month, saved 98 hours of call center staff time, automated 95% of phone responses, processed 1,200 cancellations without any human interaction, and more, according to the announcement.
“The team would spend three hours a day simply listening to patient voicemails and then go and cancel appointments,” Michelle Winfield-Hanrahan, RN, UAMS chief clinical access officer and vice chancellor for access, said in a statement. “Our results were very positive and truly exceeded my expectations.”
Athenahealth integrates behavioral health
To enable personalized care, EHR company athenahealth launched athenaOne for behavioral health. The suite includes treatment plans, group therapy opportunities, customized session documentation, a privacy toolkit, patient engagement tools and more, announced by athena last week.
“Behavioral health providers strive to provide comprehensive, meaningful care, but they often face a storm of challenges that can get in the way of providing care that achieves desired health outcomes,” Chad Dodd, the company’s vice president of product management, said in a statement.
The novel certified platform also includes mental health practice and revenue cycle management tools with workflows and built-in services for coordinated care.
By integrating behavioral health and primary care into one solution that supports a variety of care models, including outpatient behavioral health practices, acute outpatient programs, and partial hospitalization programs, providers can access relevant patient data from across the entire healthcare ecosystem in one view.
On the novel platform, patients can also make appointments themselves and communicate with healthcare providers and staff.
Clarify runs artificial intelligence to control performance
Because time-honored analytics tools do not provide the actionable intelligence that optimizes provider networks and effectively manages costs, Clarify Health said it is using Clara IQ artificial intelligence to enhance the value of health plans.
“Our industry continues to struggle to provide more effective care for every dollar spent,” Todd Gottula, founder and president of the company, said in a statement. “We have invested significantly in developing fully integrated metrics and benchmarks. This allows health plans to analyze in detail provider performance, utilization patterns, referrals and clinical populations.”
The novel Performance IQ Suite, powered by the Clarify Atlas platform, offers direct access to performance metrics and detailed analytics, and enables providers to understand how they are assessed.
Health plans can operate this information to optimize provider performance, evaluate competitive networks, redirect referrals to high-performing specialists based on comprehensive cost and quality metrics, reduce unnecessary spending and more, Clarify said.