Florida Blue to Use New AI Tool for Prior Authorizations

By February 21, 2022 June 9th, 2022 News

The Florida-based health insurance organization plans to use a new AI-powered clinical review tool to automate prior authorization approvals.

GuideWell’s subsidiary, Florida Blue, will become the first US payer to automate prior authorization approvals through a new artificial intelligence-powered clinical reviews tool developed by health technology company Olive.

According to Guidewell, this partnership will transform a frustrating, labor-intensive process, resulting in faster care for patients and improved provider satisfaction.

“Olive’s AI platform helps GuideWell create a best-in-class utilization management model that reduces the administrative burden on our providers while creating a better experience for our members,” Elana Schrader, MD, Florida Blue senior vice president, healthcare services, and GuideWell Health president, said in a press release. “By being the first health plan to automate approvals, we are leading the way for insurers to close the technology gap to better serve our members and providers.”

The prior authorization process tends to be time-consuming and inefficient for both providers and payers, requiring phone calls and faxes to exchange patient medical records. Incomplete or inconsistent data can result in significant healthcare and authorization delays.

GuideWell’s health plan companies receive hundreds of thousands of prior authorization submissions. The new partnership aims to move prior authorization decision-making to the point of care with Olive’s AI platform.

The solution will allow members to receive authorizations faster by giving providers immediate approval from GuideWell when Olive’s AI system determines the authorization request meets the necessary medical requirements.

By enhancing decision-making at the point of care, patients can receive the proper care, at the right place, at the right time, according to the press release. Additionally, clinical staff will spend less time on administrative functions and more time on patient care.

Olive refers to this process — connecting the industry’s systems to more rapidly deliver intelligence that results in better human outcomes — as creating the Internet of Healthcare.

Last year, GuideWell launched a pilot with Olive in Florida and saw a 10-day reduction in its time to make medical decisions and a 27 percent decrease in unnecessary prior authorization requests. According to GuideWell, this lessened the provider’s burden and operational costs while leading to faster patient care.

“Olive is proud to partner with GuideWell to apply automation and AI to automatically prepare, submit and deliver payer-approved prior authorizations — one of the most broken processes in healthcare today,” said Jeremy Friese, MD, president, payer market at Olive, in the press release. “Together, we are reimagining the care experience for patients, payers and providers.”

The companies will begin rolling out the AI platform in April, with a full-scale implementation for more than 2.5 million members in July.