Highmark Health is partnering with Abridge in deploying ambient clinical documentation and real-time prior authorization across the integrated health system.
Highmark Health, based in Pittsburgh, includes the Highmark Health Plan and 14 hospitals in the Allegheny Health Network.
Abridge is also based in Pittsburgh.
The first phase of the collaboration will implement Abridge’s ambient clinical intelligence platform for clinical documentation in outpatient locations and will then be deployed across the health system.
The conversation is documented through a smartphone app or laptop with web recording. The clinical note is then presented in real time within the clinician’s existing workflow. After clinician review, the notes are integrated into the patient’s electronic health record.
Allegheny reported that 92% of its patients felt their providers were more attentive during their visits when ambient scribe technology was used.
The platform also reduces physician burden, particularly of working after-hours.
WHY THIS MATTERS
Highmark Health and Abridge are also collaborating on a new near-instantaneous approval for prior authorization.
Prior authorization is a challenge for hospitals, physicians and patients due to delays in care awaiting payer approval.
The AI technology transforms a traditionally weeks-long process into one that takes minutes, according to Dr. Shiv Rao, Abridge's CEO and cofounder.
Highmark Health Plan has been processing a significant percentage of prior authorizations electronically at the point of submission, according to the Allegheny Health Network. This is through the physician Gold Carding program, a system that pre-approves doctors based in part on their historical practice patterns.
The collaboration with Abridge accelerates the approval process by comparing, in real time, Highmark’s medical authorization requirements to the information that is being collected during the patient visit. If any pieces of required documentation are missing, Abridge will prompt the physician to gather what’s needed, according to Allegheny.
By advancing the prior authorization review process to the point of conversation between patient and physician, the physician and the insurer will be on the same page from the start, accelerating approvals and supporting reduced denials for missing documentation, Allegheny said.
“This collaboration with Abridge marks another important milestone in our journey to bring prior-auth decision-making to the point of care, building upon Highmark Health’s unique Gold Carding program, and ensuring that there are no unnecessary delays in covered treatments and that our members receive care that is timely and evidence-based,” said Dr. Tony Farah, EVP, chief medical and clinical transformation officer for Highmark Health.
THE LARGER TREND
Various teams at Highmark Health, including the enterprise’s healthtech subsidiary, enGen, are helping to enable and scale these technologies.
The collaboration reaffirms the Western Pennsylvania area as a hub for developing and investing in next-generation technology.
ON THE RECORD
“Prior authorization is one of the biggest challenges facing healthcare today, and the costs of waiting for approval can be enormously significant for patients,” Rao said.
Email the writer: SMorse@himss.org