Elion

Our team has been deep-diving lately on AI in RCM, and so this convo between Bobby Guelich and Seth Jeremy Katz, MPH, RHIA, FAHIMA, VP of Revenue Cycle and HIM at University Health KC was especially interesting. He shared that while his team has explored AI prior auth and patient payments solutions, these don't yet live up to the hype. Instead, his AI priorities are: - AI coding solutions - Digital front door and patient access, such as: Self scheduling, self check in, flling out consents online, taking copay payments prior to the visit. 🟩 Q: It sounds like you’ve spent a lot of time looking into AI-driven solutions. Are there any experiences that you can share? Seth: The capabilities of AI in rev cycle are a little oversold right now in my opinion. I think certain companies like Olive were early to market and touted that they could automate just about anything. And we all saw what happened there. It was sold as, “you don't have to hire new staff, and you can release some staff, and we're going to take over all of their workflows. We can automate anything you want.” I believe it will get better, but it was just a little oversold to start with. On the other hand, I think AI coding hasn't had that problem, because coding is very rules-based. It's more structured and streamlined, and there aren't as many variables. So if it's low complexity, I think the technology is there. I think it does a great job. For more complex situations, which is what hospitals are trying to address, it's just not there yet. I believe it will get there though. 🟩 Q: On the AI coding front, what is your perspective on the vendor landscape today? Seth: My biggest disappointment is that vendors have been very slow at adding specialties. We do just about everything across our 60-odd clinics. So only being able to code five specialties is not enough for me to invest in because I'm not getting enough savings. For what it does though, the quality is really good. It works very, very well. It just doesn't do enough yet. More broadly, there are three things that make the AI coding space challenging in general: - As I mentioned, they don't cover enough specialties yet to hit a critical mass where I can save enough to cover their software license fee. - 3M and Optum have basically owned the coding tech space for decades and they're not going to just give up that space willingly. I think a lot of people are waiting to see what they do before making a choice among the main AI coding vendors. - These tech companies see themselves as SaaS, which raises a question of accountability. If the software codes something wrong, who's responsible? Historically, whether you insourced coding or outsourced it, at the end of the day, there was somebody who was responsible, whose name is on that account. I get that the vendors aren’t going to hire a fleet of coders to fight denials from their engine, but I think they need to find a way to offer accountability.

While most licensing vendors do some combination of credentialing, licensing, and enrollment to enable providers to become in-network with a payer, I wanted to share a little more of the research we've done specifically around the credentialing piece. SETTING STANDARDS When a provider organization contracts with a payer, they agree to a set of rates and standards for care provided by the payer, while also agreeing to credentialing standards for all of the clinicians in their organization that might be billing to the payer. Details such as personal information, licensure, training certifications, and liability insurance are managed in a data warehouse called CAQH Provider Data Portal, used by both providers and credentialing organizations for sharing information. In some cases, larger provider organizations undertake delegated credentialing. In this case, the provider organization performs the primary source verification and committee review themselves, allowing a new provider to see patients in a matter of weeks instead of months. In exchange, the provider orgs agree to regular audits and processes for monitoring credentialing by the payer. CREDENTIALING WORKFLOW 1. Provider updates CAQH Provider Data Portal. 2. Credentialing verification organizations (CVOs) hired to pull data from CAQH and perform primary source verification retrieve that data and verify it. 3. Each payer or provider’s credentialing committee evaluates the clinician’s qualifications and conducts interviews if necessary, to make a recommendation on the credentialing case. 4. Provider orgs are responsible for continuously monitoring clinician credentials and re-credentialing every 2-3 years to maintain standards. CREDENTIALING PLATFORMS Given all of the manual steps and data consolidation in this process, it’s easy to see why a number of tech-enabled CVOs have emerged. Their platforms connect to CAQH and primary source databases, and help automate validation tasks. Because the barriers to entry and switching costs are relatively low, there are a number of companies in this space competing both on product and on the quality of their services. This is a category in which we’ve done a number of product reviews on Andros, Certify, Medallion, Modio Health, symplr, and Verifiable. Other products in this space include Axuall, Baton Health, Credsy, HealthStream, Madaket Health, Medversant Technologies, LLC, RLDatix, and SteadyMD. Although credentialing has already been shaped in large part by automation and data integration, there is also talk of blockchain and tamper-proof records enabling instantaneous verification. We’re skeptical, since these records include background checks, work history, and in some cases, reference calls, which we would hesitate to put on a blockchain. As a result, we believe it will continue to be a services-heavy industry, with a healthy dose of competition between all of these players.

Today’s Vendor Spotlight is… Wellsheet What Wellsheet does (Elion’s take): - AI-powered Smart EHR UI that integrates with existing EHR systems like Epic, Cerner, and athenahealth.  - Assembles and summarizes critical clinical content from EHRs, clinical guidelines, and other sources into a single, intuitive view tailored to individual clinician specialties and practice patterns.  - Enhances workflows like chart review, care team collaboration, and discharge planning, reducing the length of stay and clinician time spent in the EHR. Founded: 2015 Total Funding: $12M Leadership: Craig Limoli, John Paul Patrizio, Frederik (Fred) Lindberg, Mari Mineta Clapp Core Differentiators (according to Wellsheet): - Wellsheet’s AI-powered predictive clinical workflow platform improves clinician efficiency and satisfaction - Reduces length of stay -Delivers tangible ROI of 8X Learn more about Wellsheet at https://lnkd.in/eC7esm7N. (And if you’re a healthcare vendor and want to get featured, claim and update your Elion profile today.)

Here’s your recap of last week’s health IT news 🗞️ 👇 🤖 AI Clinician Assistant • Commure announced it will acquire Augmedix in a take-private deal. • Suki announced a partnership with Federally Qualified Health Centers and Community Health Centers, including Utah Navajo Health System, Inc., CenterPlace Health , and Access Health Louisiana. • OneHealth is partnering with healthPrecision / Medical Brain to support the former’s Modern Primary Care platform. 📈 Data & Analytics • Huma announced a $80M Series D that included pharma investors AstraZeneca and Leaps by Bayer, as well as the launch of its Huma Cloud Platform, a service that promises to help digital health products scale and launch their products more efficiently. • Intermountain Health partnered with NeuroFlow to better understand its Colorado patients’ behavioral health risks. 🔁 RCM • Medmetrix acquired HRSI - Healthcare Receivable Specialists Inc., accelerating development of its end-to-end solutions. • Thoughtful AI launched new “human-capable” AI agents for claims processing, patient eligibility verification, and payment posting and announced a $20M Series A. 📋 Patient Administration • XO Health Inc. is partnering with Kyruus Health to integrate its price transparency and directory tools. 💼 Provider and Practice Administration • West Tennessee Healthcare is implementing Qventus, Inc. 📱 Patient Support and Communications • Vizient, Inc has contracted with Mytonomy on behalf of its hospital and health system customers. • Tendo added FlyteHealth to its marketplace. • Epic offers a new integration with United Language Group allowing providers to dial-in an interpreter directly from the patient care workflow. ⚙️ Clinical Operations • Wolters Kluwer Health released an update to its UpToDate Pro software designed to support PCPs in prescribing, switching, and titrating antidepressant prescriptions. • Fullscript released two new studies demonstrating higher engagement and improved patient labs. 🍎 VBC • Guidehealth is now offering Story Health to its partner health systems. • Astrana Health is partnering with Elation Health to offer its EHR platform and billing technology to its customers. • Thyme Care closed a $95M series C, including healthcare funds such as CVS Health Ventures, Concord Health Partners, and more. 🧠 Food For Thought • A recent study found that Chat GPT-written patient portal messages were comparable in quality (and better on measures of empathy and communication style) to those drafted by healthcare professionals, according to PCP reviewers. We’re always interested to see physicians’ responses to GenAI solutions, as the tide turns toward greater acceptance of the technology. https://lnkd.in/gMX7ATX2 --- Want the latest healthcare tech news delivered to your inbox each week? Sign up here 📬 👉 https://lnkd.in/e2UJ3ckP

Today’s Vendor Spotlight is… emtelligent What emtelligent does (Elion’s take): - Healthcare AI language solution, trained on billions of data points and 2M hand annotations.  - Uses NLP and medically-aligned LLMs to structure medical text and unlock insights at enterprise scale Founded: 2016 Total Funding: Private Leadership: Tim O'Connell Anoop Sarkar Core Differentiators (according to emtelligent): - Our solution uses medical AI and LLMs to transform unstructured clinical records into structured data, driving value across many healthcare sectors. Learn more about emtelligent at https://lnkd.in/eMqNjWMK. (And if you’re a healthcare vendor and want to get featured, claim and update your Elion profile today.)

Today’s Vendor Spotlight is… Layer Health Distill What Layer Health Distill does (Elion’s take): - AI chart review platform that uses LLMs to analyze clinical notes.  - Supports a variety of use cases such as registry submissions, quality measurement, and clinical documentation improvement. Founded:  Total Funding:  Leadership: David Sontag Divya Gopinath Luke Murray Monica Agrawal Steven Horng, MD, MMSc, FACEP Core Differentiators (according to Layer Health): - Layer Health has built an LLM-powered platform to automate chart review for a range of high-impact use cases. We provide insights to power a range of quality and value-based care use cases and integrate into existing workflows or provide custom end-to-end modules. Learn more about Layer Health Distill at [https://lnkd.in/eCxZ7geX. (And if you’re a healthcare vendor and want to get featured, claim and update your Elion profile today.)

Today’s Vendor Spotlight is… Notable HCC Chart Review What Notable HCC Chart Review does (Elion’s take): - Uses AI to analyze patient histories – including clinical notes, claims, and other data sources – to identify new and recapture hierarchical condition category (HCC) codes.  - Provides evidence-based recommendations to providers during patient visits through EHR integration - Supports medical coders, helping improve the accuracy of risk adjustment in both prospective and retrospective HCC workflows. Founded: 2017 Total Funding: $127M Leadership: Pranay Kapadia Adam Ting Justin White Learn more about Notable HCC Chart Review at https://lnkd.in/ei_iACwN. (And if you’re a healthcare vendor and want to get featured, claim and update your Elion profile today.)

Today’s Vendor Spotlight is… Autonomize AI Medical Chart Review What Autonomize AI Medical Chart Review does (Elion’s take): - Streamlines chart review by transforming patient data into better structured, searchable information.  - Consolidates data from multiple sources and formats, allowing healthcare professionals to efficiently summarize and analyze patient records. Founded: 2022 Total Funding: $4M Leadership: Ganesh Padmanabhan Kris Nair Core Differentiators (according to Autonomize AI): - Autonomize AI Copilots for Healthcare and Life Sciences organize, contextualize, and summarize unstructured data to reduce the administrative burden for healthcare knowledge workers, enabling them to make data-driven decisions, lower costs, and improve patient outcomes. Learn more about Autonomize AI Medical Chart Review at https://lnkd.in/eYmdWReR. (And if you’re a healthcare vendor and want to get featured, claim and update your Elion profile today.)

Here’s your recap of last week’s healthcare technology news 🗞️ 👇 🤖 AI Clinician Assistant • Carle Health is beginning a full-scale adoption of Nabla through their Epic integration.    • UVM Health Network signed an enterprise-wide agreement with Abridge.    • Regard closed a $61M Series B with an investment from Cedars-Sinai Health Ventures among others.    • Mass General Brigham published a Q&A discussing the results of its initial AI ambient scribe pilot and plans to roll out a wider implementation.    🔁 RCM • Greenway Health released a patient payment solution that integrates cost estimates, patient payments, and payment plans.    💼 Provider and Practice Administration • Kontakt.io released a new wearable tag that aims to enable understanding of patient journey, estimated wait times, room availability, physician time with patient, and more.    📋 Patient Administration • Cone Health is partnering with Lirio on an AI-driven intervention for patients with diabetes.    • SAIGroup acquired Get Well, giving it access to the firm’s AI platform. 🍎 VBC • P3 Health Partners is partnering with Innovaccer to leverage its physician engagement solution as well as its AI-driven analytics.    • HSBlox, Inc released an update to its CureAlign platform that includes tooling for improved care coordination and patient outreach.    • GrayHawk Health is implementing Innovaccer to optimize operations and improve efficiency. 🧠 Food for Thought • We’ve covered numerous studies in our newsletter highlighting the impact of tech on reducing physician burnout. It appears we’re finally seeing signs of widespread impact from these workflow and workload interventions: physician burnout dropped below 50% for the first time since 2020, according to the AMA. https://lnkd.in/eWhj94NB    • ONC released the new, proposed rule HTI-2 to advance interoperability and patient information access and sharing. We're looking forward to more expert takes in the coming days—feel free to send any good ones our way! https://lnkd.in/eyM7eDyq --- Reminder: you can sign up for the Elion Briefing to get the latest healthcare tech news delivered to your inbox each week 📬 👉 https://lnkd.in/e2UJ3ckP

Today’s Vendor Spotlight is… Clearstep What Clearstep does (Elion’s take): - Conversational AI platform that enables virtual triage, patient services, and clinical journey management - Solutions including a symptom checker for self-triage, automated patient engagement chatbots, and a chatbot for managing follow-ups and remote monitoring after hospitalization. Founded:  Total Funding:  Leadership: Adeel Malik Bilal Naved Core Differentiators (according to Clearstep): - Clearstep's Virtual Triage is unparalleled in its accuracy and efficiency, largely because it is built in partnership with Dr. Schmitt (co-author of the gold-standard Schmitt-Thompson triage protocols used in 95% of nurse call centers in the US). Clearstep is the only chat-based AI solution with a contractual license to utilize these protocols.  - Clearstep's Virtual Triage asks the fewest questions (~10 fewer than other symptom checkers) necessary to accurately determine the patient's next best course of action.  - Clearstep can integrate specialists' scheduling decision trees, typically used by human call center agents, into an automated, self-service workflow that starts with triage and enables self-service booking for specialist care.  - Multilingual: Virtual Triage is available out-of-the-box in English and Spanish Learn more about Clearstep at https://lnkd.in/enT-TmTt. (And if you’re a healthcare vendor and want to get featured, claim and update your Elion profile today.)