Welcome to the Empowered Patient Podcast with Karen Jagoda. This show is a window into the latest innovations in applying generative AI, novel therapeutics and vaccines, and the changing dynamics in the medical and healthcare environment. One focus is on how providers, pharmaceutical companies, and payers are empowering patients. In addition, conversations are often about how providers, care facilities, pharmaceutical companies, and payers are being empowered by technology to improve patient outcomes and reduce friction across the healthcare landscape.
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Jul 3, 2024
Kim Perry, Chief Growth Officer at emtelligent, focuses on using medical AI in the prior authorization process to structure unstructured medical text in patient records, making whole record healthcare possible. AI can be used to extract relevant information from faxed or PDF medical records, saving time and improving efficiency over existing manual processes. For payers, there is potential for medical AI to address other processes such as risk adjustment, care management, quality measures, and payment integrity in an environment still lacking interoperability and reliant on highly trained humans.
Kim explains, "For prior authorization in particular, well over 50% of our prior authorizations here in this country are manual. And that means once a prior authorization is submitted for a request for a procedure or a specialty drug, it's a cue for a clinician to review. And part of that review process is to pull a patient's record."
"Unfortunately, because of the lack of interoperability in the healthcare ecosystem, that record is often a fax and a PDF, which could be hundreds of pages. So, the clinician is tasked to manually read through that PDF to find the clinically relevant information to help them deny or approve the prior authorization. So, what they're doing here is using AI to pull out the relevant information at the time that's needed so the clinician doesn't have to manually read through all hundreds of pages looking for the needle in the haystack, if you will, of the information that they're looking for to solve that problem in that point in time."
"I think people assume that with the adoption of EMRs, everything will be digital. But again, due to the lack of interoperability or the lack of payers, in this case, getting direct access into the EMRs for the clinical data, there has to be a way to transmit the information, the relevant information. And often, as I mentioned, it's fax-based. The health systems or the providers are faxing over medical records to the payers. Today, the payers are forced to do that manual review because they haven't had the tools available to them until now to help them apply technology to that manual review process."
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