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Brian T. Horowitz
April 14, 2023
4 Min Read
Fabrizio Fadda via Alamy Stock Photo
Google Cloud is tackling the cumbersome problem in healthcare of slow preauthorization of recommended procedures, medications, or devices. On April 13, the company introduced its AI-enabled Claims Acceleration Suite to reduce these administrative burdens and costs for health plans and providers.
The prior authorization process causes burnout for physicians, notes Amy Waldron, director of Global Health Plans Strategy and Solutions for Google Cloud. In fact, 88% of physicians call it “very or extremely” burdensome, according to the Medical Group Management Association.
The Centers for Medicare & Medicaid says prior authorizations take an average of 10 days. The manual process involves health plans reviewing physicians’ prior authorization requests, which they send in unstructured formats such as PDF. Google Cloud’s Claims Data Activator addresses this burden for healthcare customers by converting unstructured data into structured data.
“The Claims Acceleration Suite technology makes it easier for health plan administrators and providers to leverage existing patient, diagnosis, procedure, and coverage data to quickly assess if more information is needed and rapidly approve the prior authorization requests,” Waldron tells InformationWeek. “With Google Cloud's AI-enabled solutions, healthcare companies can extract value from the data exchanged for completing the transactions and reduce the manual administrative work for providers and health plans.”
The AI tools will free up healthcare insurers from manual data entry to spend more time on evaluating and reviewing claims without the burden of unstructured formats of data. Claims Activation Suite accelerates the data flow between payers and providers, according to Waldron.
“Converting unstructured data to structured data with our Document AI and being able to enrich the data for review by leveraging our Healthcare Natural Language AI enables our customers to serve the reviewers and decision-makers better information faster, reducing administrative manual interventions and speeding time to decision and access to care,” Waldron says.
Previously, healthcare providers shared information in unstructured PDF format and converted health record data from faxes and images, Waldron explains.
“The Claims Acceleration Suite’s Claims Data Activator uses Document AI, Healthcare Natural Language API, and Healthcare API to convert this unstructured data to structured data and establish data interoperability,” Waldron says. “This speeds up the process, and significantly reduces administrative burdens and costs, enabling experts to make faster, more informed decisions that improve patient care.”
A quick prior authorization process is essential to speeding up the process for a patient who may need approval for transportation to an important medical procedure such as a colonoscopy, according to Waldron. Patients also seek prior authorizations to use a digital device as part of weight management or a care management plan for conditions such as diabetes.
How the Claims Data Activator Works
A goal of Google’s Claims Data Activator is to make healthcare prior authorization data more interoperable, or accessible for all parties. It incorporates real-time analytics and ML from Google Cloud’s BigQuery enterprise data warehouse and data visualization from the company’s Looker business intelligence and data analytics platform.
Meanwhile, Google Cloud will work with Myndshft to offer real-time benefits verification and calculation of providers’ contracted rates and submission of prior-authorization requests. It also integrates with Pega Care Management to provide guided workflow tools through the authorization process and incorporates intuitive search and automated letter generation.
“Myndshft integrates with the existing clinical systems to optimize the prior authorization submission workflow for the healthcare providers,” Waldron says. “Health plan administrators and clinical reviewers can use Pega to expedite the prior authorization review for medical necessity. Myndshft’s and Pega’s technologies integrate with Google’s Claims Data Activator using standards-compliant APIs.”
Blue Shield of California Automates Prior Authorization Requests
Blue Shield already had a partnership with Google Cloud, teaming up to automate medical billing and payment using AI and ML, and now the health payer has been piloting the Claims Acceleration Suite since February. Blue Shield receives about 1 million prior authorization requests each year, according to Lisa Davis, senior vice president and CIO at Blue Shield of California.
“In processing these requests, 30% of time is spent on intake and 70% is on applying business rules to determine who should review and decision the request,” Davis tells InformationWeek. “The 30% is what we are working to automate with Google.”
By speeding up the process, which includes a clinical review, health plan members can access care faster.
“Streamlining the prior authorization process helps our providers ensure their patients get timely access to care,” Davis says. “The artificial intelligence tool helps us facilitate quicker human evaluation of prior authorization requests to ensure our members are getting the highest quality, affordable care in the quickest time possible.”
Meanwhile, international healthcare company Bupa is also using Claims Acceleration Suite.
“The Claims Acceleration Suite's AI-enabled prior authorization will help us more quickly meet the needs of the people we serve in Brazil, improving overall experience through frictionless access to care,” Cibele Cardin, IT director for Care Plus, a subsidiary of Bupa in Brazil, said in a statement. “We are working with our global colleagues to make the AI-tooling available to Bupa's operations in Poland and Spain."
Google Cloud’s AI-enabled prior authorization is available now, and the company will add additional features to the Claims Acceleration Suite later this year.
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About the Author(s)
Brian T. Horowitz is a technology writer and editor based in New York City. He started his career at Computer Shopper in 1996 when the magazine was more than 900 pages per month. Since then, his work has appeared in outlets that include eWEEK, Fast Company, Fierce Healthcare, Forbes, Health Data Management, IEEE Spectrum, Men’s Fitness, PCMag, Scientific American and USA Weekend. Brian is a graduate of Hofstra University. Follow him on Twitter: @bthorowitz.
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