In an interview with InformationWeek Healthcare, Lori Beer, WellPoint's executive VP of specialty businesses and information technology, said the Watson-based application could potentially lead to pre-approvals in near-real time, as compared to 24 to 72 hours today.
Currently, she said, utilization management nurses spend 40% to 60% of their time aggregating information that is faxed or mailed to them. Then they have to decide whether the request is based on evidence-based medicine and accords with WellPoint medical policies before approving or denying it.
In a pilot, she said, the nurses found they could accept Watson's recommendations on pre-authorization 90% of the time. And the more data they put through it, the more accurate the analysis becomes. Even when they have to do additional research on a request, Watson's ability to aggregate the information and present it to the nurses in a readable, structured format saves a lot of time, Beers added.
Providers like Memorial Sloan Kettering are also pleased with the Watson pre-authorization approach, she said, because it reduces their paperwork and allows their clinicians to spend more time with patients. Most doctors don't mind having a computer identify which requests are evidence-based, she said, because medical knowledge is increasing so fast they need decision support to keep up with it.
WellPoint's utilization managers will continue training Watson on new procedures, she noted, until those accounting for about 80% of cases requiring preauthorization are covered.
Starting at the conference of the Healthcare Information and Management Systems Society (HIMSS) next month, she said, WellPoint and IBM will sell the Interactive Care Guide and Interactive Care Reviewer to other health insurers. Some of those will be competitors to WellPoint plans, Beer acknowledged. But how they use the technology will determine who wins in the market. "It's not just the capability, it's how you redesign the rest of your processes," she said.
Although the plans will supply the Watson-based preauthorization tools, she said, the providers will have to pay for their own interfaces to Watson. But in many cases, she added, this investment will occur in the context of value-based reimbursement that rewards providers for sharing clinical data with payers and letting them combine it with their claims data.
Federal Meaningful Use Stage 2 requirements will make your medical organization more competitive -- if they don't drive you off the deep end. Also in the new, all-digital Meaningful Mania Part 2 issue of InformationWeek Healthcare: As a nation, we're falling short of the goal of boosting efficiency and saving money with health IT. (Free with registration.)