What You Should Know:
– GuideWell, one of the 10 largest health insurance providers in the U.S., became the first U.S. payer to automate prior authorization approvals through AI-powered clinical reviews from Olive, resulting in faster care for patients — up to 10 days faster — and greater provider satisfaction.
– After launching a pilot with Olive in Florida, GuideWell saw its time to decision reduced by 10 days when immediate responses were available, decreased unnecessary prior authorization requests by 27%, and experienced 48% faster decisions, lessening the amount of time patients had to wait for care.
Time-Consuming Prior Authorization Process
For most of the industry, the prior authorization process is a time-consuming endeavor for both providers and payers, requiring phone calls and faxes to provide patient medical records. Incomplete and inconsistent data can cause delays and lead to a 15-day cycle before a member receives authorization for a procedure. GuideWell’s health plan companies receive hundreds of thousands of prior authorization submissions.
By deploying Olive’s AI platform, prior authorization decision-making moves to the point of care (such as a doctor’s office). The solution will enable members to receive authorizations faster by giving providers an immediate approval from GuideWell (sometimes before a member leaves their provider’s office) when Olive’s artificial intelligence determines the prior authorization request meets GuideWell’s medical necessity requirements.
This increase in decision-making at the point of care provides patients with the right care, at the right place, at the right time. As a result, clinical staff 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.
GuideWell launched a pilot with Olive in Florida last year and saw impressive results: a massive reduction in time to decision by 10 days when immediate responses were available and a 27 percent decrease in unnecessary prior authorization requests, lessening the provider’s burden and operational costs and 48 percent faster decisions leading to faster patient care.
The companies will begin rolling out the AI platform in April, with a full-scale implementation in July for more than 2.5 million commercial members.
“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,” said Dr. Elana Schrader, Florida Blue senior vice president, healthcare services and GuideWell Health president. “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.”