Highmark Health recently announced a partnership with AI technology company Abridge to deploy its ambient clinical documentation platform across Allegheny Health Network and co-develop a new prior authorization solution.
It’s a meaningful step. But declarations alone won’t fix a system still powered by fax machines, phone calls, and inconsistent rules. Real progress will require a modern digital infrastructure, aligned incentives, and coordinated action across both the public and private sectors.
Neurologists and health care practitioners must evolve with the world. Telemedicine carts assist in this evolution by serving as an intermediary between patients and doctors.
Without systemic redesign, these efforts risk reinforcing the same pain points that made prior authorization a flashpoint for payers and providers.
By keeping our AI and ML grounded in real-world medicine, we can shape a future where prior authorization works smarter, faster, and better for everyone involved.
Ochsner Health is expanding its use of Latent Health’s AI platform after its reduced medication prior authorization times to just 4-5 minutes. The technology is designed to both streamline pharmacists’ workflows as well as improve patients’ access to medications.
Several insurers, such as UnitedHealthcare, Aetna and Cigna, pledged to improve prior authorization. These changes include streamlining decision timelines and increasing transparency.
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Cohere Health introduced a new tool for payers called Review Assist. It is meant to support health plan clinical staff with prior authorization reviews and other use cases.
Managing routine radiology does not require the administrative burden of prior authorization. Instead, health plans can implement post-service, pre-payment automated management based on clinical guidelines.
The current prior authorization process in U.S. healthcare constitutes a crisis, according to Jesse Ehrenfeld, immediate past president of the American Medical Association. Prior authorization is wasting clinicians’ time, delaying care and deepening public distrust — yet, payers show little urgency in fixing this problem, he said.
While prior authorization has made many headlines over the past year, concurrent review has not. Yet missteps in both processes leave hospitals in danger of not getting paid, which can result in higher costs being passed down to patients.
Yusuf Qasim, President of Payments Optimization at Zelis, discussed how the company is transforming healthcare payments from a fragmented, patchwork system into a modern, digital infrastructure.
The tools exist today to significantly reduce PA's burden on our healthcare system, we just need to mobilize and implement them.
Cohere Health raked in $90 million in Series C capital, taking its total funding to date to $200 million. This round of funding cements Cohere as the emerging winner in the prior authorization tech category, according to Michael Greeley, general partner at Flare Capital Partners.
Several states and insurers have gold carding programs to streamline prior authorization. However, some say they're falling short.
AI tools can work together across the payer value chain, exchanging information, collaborating and making autonomous decisions based on business rules. Here are just a few examples of how their bottom lines are benefiting.
With these tools, therapists can reclaim their time, focus on their patients, and deliver the high-quality care that every individual deserves — all while maintaining the financial stability to thrive in their practices.