Google on Thursday announced a suite of artificial intelligence tools to help speed up one of healthcare’s big administrative bottlenecks: prior authorization.
This is the process where a doctor needs to file a request with a patient’s health insurer before moving ahead with certain tests, imaging, surgeries or prescriptions. It has remained a largely manual process on both sides with humans sorting through the unique details of a patient’s health plan and medical history across faxes, PDF documents, phone calls and online portals.
The idea of getting health information to flow between patients, providers and insurers may sound basic, but exchanging data across different systems, known as interoperability, remains one of the biggest challenges in healthcare. A consequence can be delays in people getting the care they need, which can exacerbate health conditions and lead to worse outcomes. This is one reason why the federal government has proposed new rules to speed up prior authorization in certain government-funded health plans that would require urgent requests to be processed within 72 hours and regular requests in 7 calendar days – twice as fast as the existing requirement – by 2026.
The software from Google’s cloud unit, called Claims Data Activator, is focused specifically on helping health insurers clean up the data in whatever form it comes in from healthcare providers with an eye towards speeding up the prior authorization process. It relies on a combination of several existing Google AI models that can extract information from documents and organize it in a standardized format to make it easier and faster for the human reviewer. The tools will also allow health insurers to analyze the data and to share information electronically with doctors and hospitals.
Google says these tools are geared towards simplifying the process, not giving recommendations. “We are not automating a yes or no,” says Amy Waldron, director of global health plans strategy and solutions at Google Cloud. “Our whole goal is to shrink the amount of time of getting the information from the provider to the reviewer and making the best use of that reviewer’s time.”
As part of the broader “Claims Acceleration Suite,” Google is recommending tools from two other companies – Myndshft and Pega – that have built solutions using Google Cloud. Myndshft’s software helps doctors and hospitals check a patient’s insurance benefits and submit the prior authorization claim to the insurer. Pega offers workflow software that helps insurers manage the prior authorization review process. “We don’t want to sit there and compete with existing systems that the healthcare industry is using
