Google Launches 3 AI Tools For Faster Health Preauthorizations

Source: @Google on Twitter

Google has unveiled new artificial intelligence (AI) tools to improve healthcare efficiency. The company has announced a suite of products designed to streamline current prior authorization processes.

Preauthorization methods used by insurers have long delayed or stopped patients from receiving necessary tests, medications, or treatments. Google hopes to change that. 

Use Case for AI in Prior Authorizations

The prior authorization process requires physicians, facilities, and pharmacies to obtain pre-approval for certain diagnostics, procedures, and drugs. Insurance companies collect essential information through disorganized faxes, electronic portals, or phone conversations with service providers, and then they make coverage decisions based on what is obtained. 

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It is a laborious and time-intensive process for most payers. 

The purpose is to control care quality, safety, and cost. Yet, anyone who has worked in health care understands that, as a result, all parties wind up investing major resources (time, money, etc.) in the process. This leads to frustration for patients, doctors, hospitals, and insurance companies.

Delays caused by the prior auth process often lead to delays in care. According to at least one document, the standard review time frame is up to ten business days, excluding holidays.

At least 30 percent of doctors say that the prior authorization process has led to a serious adverse event for a patient in their care.

Furthermore, the back-and-forth communication and additional paperwork are expensive. The Council for Affordable Quality Healthcare estimated that prior authorization transactions cost the US healthcare system $767 million in 2020.

Preauthorization Inefficiencies in Healthcare

Preauthorization inefficiencies have been such a problem for the healthcare industry that the federal government stepped in. According to a recent press release, the Centers for Medicare and Medicaid Services (CMS) has proposed a rule that would require the following:

• Urgent requests are to be answered within 72 hours 

• Routine requests are to be handled within seven calendar days

• Payers must implement electronic systems to streamline the review

The Google Claims Acceleration Suite offers three tools to help health insurance companies speed up the process.

“It’s time to modernize the prior authorization process, leverage current technology to improve access to care, and extract value to better serve the people in our communities,” Amy Waldron, Google’s Cloud Director of Global Health Plans Strategy and Solutions, said in a press release.

Google’s 'Claims Acceleration Suite' - 3 Tools

Google has partnered with two other Google Cloud-based solutions—Myndshft and Pega—already used by doctors and hospitals. “We don’t want to compete with existing systems the health care industry is using,” Waldron told Forbes. 

The Claims Acceleration Suite has three components:

• Prior Authorization Submission, by Myndshft

• Claims Data Activator, by Google

• Prior Authorization Review, by Pega

Myndshft checks benefits and helps providers submit prior authorization claims. Pega provides workflow software and helps insurers manage the review process.

Claims Data Activator is Google’s new AI feature. It scrubs electronic submissions to extract data. Then it turns unorganized information into structured data so that the professionals can make better decisions that streamline patient care. 

Google’s Claims Acceleration Suite is built on Google Cloud’s current healthcare infrastructure, which includes HIPAA-compliant security and compliance capabilities. 

The suite connects with existing systems and workflows but is flexible and can be customized to suit each insurance organization’s needs. For instance, the AI Prior Authorization Assistant can be taught criteria, policies, and procedures for specific insurance carriers. Also, the Claims Decision Support module may be configured to include different data sources and conditions, depending on the payer.

The product line uses AI to reduce administrative burdens and costs while improving patient experience.

So far, there are two notable early adopters of Google’s Claims Acceleration. 

Source: Blue Shield of California Facebook

Blue Shield of California is using Google’s AI tools to streamline prior authorization claims for its 4.8 million members in the US. 

Bupa, an international healthcare management company, is also using Google to improve the experience for its 38 million global customers.

The software is available now. Additional features are slated to launch later this year.

The Future of AI in Healthcare

Google isn’t the only tech company harnessing AI and cloud computing to transform the healthcare industry. Microsoft just launched the Microsoft Cloud for Healthcare, which includes capabilities such as virtual health consultations, remote patient monitoring, and data analytics.

The existing state of the US healthcare system is complex and inefficient in many respects. These factors contribute to high pricing and poor patient outcomes. 

Many forward-thinking companies, including Google and Microsoft, have focused on it. These companies aspire to improve the overall patient experience by combining artificial intelligence and cloud computing to speed up operations, improve decision-making, and, ultimately, improve the overall patient experience.

However, some worry about the possible hazards and ethical issues associated with using AI in healthcare. For instance, how can companies ensure the algorithms are fair and do not perpetuate inequities in healthcare access and outcomes?

Despite these hurdles, healthcare will likely remain a top priority for technology companies in the future. As more data is collected and the demand for efficient and effective healthcare services develops, AI and cloud computing are set to play a growing role in improving the quality and accessibility of care globally.