Highmark Health, Abridge Partner to Scale AI for Payers/Providers

Highmark Health has partnered with healthcare AI company Abridge to roll out its ambient clinical documentation platform and co-develop a prior authorization solution, the companies announced Tuesday.

Pittsburgh, Pennsylvania-based Highmark Health is the parent company of Highmark, a health insurer with more than 7 million members, and Allegheny Health Network, a health system with 14 hospitals. Abridge, also based in Pittsburgh, offers an AI platform that aims to improve patient outcomes and reduce administrative burdens for providers.

Through the partnership, Abridge’s ambient clinical intelligence platform will be integrated at Allegheny Health Network office locations and hospitals. The platform takes patient-clinician conversations and turns them into clinical notes. After gaining consent from the patient, conversations are recorded using a phone or computer. Clinical notes are created in real time within the clinician’s workflow, and the clinician is able to review and edit the notes before adding them to the patient’s EHR.

Using this technology reduces the amount of time clinicians have to spend taking notes and allows them to spend more time with patients, according to the companies. The implementation of Abridge’s ambient technology will start at outpatient locations, but will eventually be deployed across the entire health system.

Highmark Health and Abridge are also working together on building a new prior authorization technology. During patient visits, the technology will identify when prior authorization is needed and ask the clinician to fill in missing information for the authorization before the patient leaves the room.

“The platform will automatically generate the request with all of the information required for approval in real-time,” an Abridge spokesperson told MedCity News. “Abridge’s Linked Evidence architecture allows the clinician to seamlessly verify everything in the AI generated note and request the source transcript and audio from the conversation, so they can be sure information is accurate and comprehensive.”

This builds on Highmark Health’s Gold Carding program, which awards gold cards to practices and physicians with a proven track record of high prior authorization approval rates. Once gold carded, physicians only need to submit a prenotification to schedule services, and approval is granted immediately. Highmark Health also offers an Active Gold Carding program, through which Highmark works directly with clinicians, offering coaching to help them submit accurate and clinically appropriate requests.

“While those [gold carding] initiatives can increase prior authorizations happening at the point of care post-encounter, Abridge’s technology prompts clinicians for necessary information during patient visits, leading to faster approvals and fewer denials, which ultimately helps patients maintain continuity of care,” said Richard Clarke, PhD, SVP, chief analytics officer of Highmark Health, in an email.

Ultimately, this partnership between Highmark Health and Abridge aims to improve health outcomes and make care more affordable, Clarke added.

“Patients will have more face time with their doctors thanks to the ambient scribe technology that we are adopting at [Allegheny Health Network],” he said. “Follow-up care will be approved more efficiently through the prior-auth solution. As the collaboration matures, we will look for other ways to creatively deploy AI tools and solutions within our existing workflows, and throughout the care continuum.”  

Photo: Abridge and Highmark Health