Several healthcare IT vendors have unveiled new offerings that help health systems improve patient access, address provider burdens and drive cost optimization over the past week. 

Oracle Health said Monday that it wants to help tame provider administrative challenges by replacing manual processes with cloud-based automated claims processing, while Luma Health on Tuesday released machine learning and natural language processing enhancements to transform workflows.

Also this past week, athenahealth said it aims to improve holistic care delivery with new behavioral health integration in its cloud-based electronic health records. And Clarify Health hopes to foster greater transparency and build trust by offering direct access to performance measures and predictive analytics that span cost, quality and utilization.

Oracle leverages FHIR

Oracle said the general availability of automated data exchange between healthcare providers and payers will change the way authorizations are handled.

"Healthcare has long been plagued by costly, time-intensive and antiquated claims processing that results in billions of unnecessary fees each year, and ultimately a strained relationship between providers and payers," Seema Verma, executive vice president and general manager of Oracle Health and Life Sciences, said in a statement. 

About 70% of authorizations are handled by phone or fax, with payers and providers sharing about 25% of documents related to reimbursement, Oracle said. 

The new clinical data exchange platform could help tame the burden of administrative tasks and move providers and payers away from these manual processes by sending medical records through a secure, centralized network. It also helps providers streamline payer data request responses and ease the staff burdens, according to Kent Hoyos, vice president and chief information officer at Pomona Valley Hospital Medical Center.

Providers select what data to make accessible to their payer partners in the platform and can audit selected clinical data with chosen payers to confirm exactly which data was received, according to Oracle. Payers retrieve clinical data via FHIR queries or bulk processing in an industry-standard format with no additional point-to-point connections required.

Faster payer responses and claims reimbursements could also hasten the speed of patient care.

"Automating the process will help speed approval of necessary patient clinical services as well as payment processing and shorten the wait time for our patients to receive the care they need," Hoyos said in a statement.

Luma automates with genAI

San Francisco-based Luma Health announced two new artificial intelligence products for its patient success platform on Tuesday. The multi-model generative AI named Spark can be used to address common operational challenges for health systems, including high call volume and manual fax processing.

"Our vision is to use this latest groundbreaking technology to solve persistent challenges on a massive scale, and now the technology is equipped to help us deliver a next-generation patient experience," Aditya Bansod, Luma's co-founder and chief technical officer, said in a statement.

"Health systems are doing more than ever to serve their patients with fewer staff and resources, and they don't have time to waste on AI solutions that offer shallow EHR integration or create more overhead," Luma's co-founder and CEO Adnan Iqbal added. 

"That's why we focused Spark on the most common challenges we hear from health systems: high call volume, backlogged referrals, lost revenue and not enough staff to handle it all manually."

Woven into the company's patient success platform, Spark has bi-directional integration with leading EHRs, including Oracle Health, Epic, eClinicalWorks, Meditech, athenahealth, NextGen and Greenway Health, Luma said.

The first two Spark-enabled tools automate fax processing – Luma's Fax Transform – and provide a patient-facing voice AI concierge – Luma's Navigator.

Provider staff can use Luma's Fax Transform to automatically parse structured data from faxes including referrals, prescription refills and more, to verify information then the referral is automatically created in a health system's EHR. 

DENT Neurologic Institute said it is experiencing three times faster fax processing and 70% time savings on fax workflows with the new tool.

"We receive a lot of faxes – over 500 per day across the organization – and it's just impossible to keep up with manually," Emily Smythe, the institute's manager of quality and analytics, said in a statement. 

"Processing a single fax can take up to five minutes. Fax Transform automates it completely, so it takes 10 seconds or less to file a fax."

The University of Arkansas for Medical Sciences adopted Luma's AI concierge and within one month saved 98 manual call center staff hours, automated 95% of phone call responses, processed 1,200 cancellations without any human interaction and more, according to the announcement.

"The team was spending three hours daily just listening to patient voicemails and then going in and canceling appointments," Michelle Winfield-Hanrahan, RN, UAMS' chief clinical access officer and associate vice chancellor for access, said in a statement. "Our outcomes have been very positive, and really exceeded what I expected."

Athenahealth integrates behavioral health 

To enable personalized care, EHR company athenahealth has launched athenaOne for Behavioral Health. The suite includes treatment plans, group therapy capabilities, tailorable session documentation, a privacy toolkit, patient engagement tools and more, athena announced last week.

"Behavioral health providers strive to provide comprehensive, meaningful care but are often faced with a perfect storm of challenges that can get in the way of delivering care that achieves desired health outcomes," Chad Dodd, the company's vice president of product management, said in a statement.

The new certified platform also includes mental health practice and revenue cycle management tools with workflows and embedded services for coordinated care. 

By integrating behavioral health and primary care into one solution that supports various care models, including outpatient behavioral health practices, intensive outpatient programs and partial hospitalization programs, providers can access relevant patient data from across the healthcare ecosystem in a single view.

Patients can also self-schedule appointments and communicate with providers and staff on the new platform.

Clarify launches AI for performance control

Because traditional analytics fall short of delivering actionable intelligence that optimizes provider networks and manages costs effectively, Clarify Health said it is leveraging its Clara IQ artificial intelligence to empower health plans to drive value. 

"Our industry continues to struggle with delivering more effective care for each dollar spent," Todd Gottula, the company's founder and president, said in a statement. "We've invested significantly in developing fully integrated measures and benchmarks. This enables health plans to understand provider performance, utilization patterns, referrals and clinical populations at a granular level."

The new Performance IQ Suite, powered by the Clarify Atlas Platform, offers direct access to performance measures and detailed analytics and also enables providers to understand how they are evaluated. 

Health plans can use the insights to optimize provider performance, assess competitive networks, redirect referrals to high-performing specialists based on comprehensive cost and quality metrics, reduce unnecessary spending and more, Clarify said.

Andrea Fox is senior editor of Healthcare IT News.
Email: afox@himss.org
Healthcare IT News is a HIMSS Media publication.