Highmark Health plans to roll out Abridge's ambient clinical documentation technology across its entire organization, which includes 14 hospitals and hundreds of clinics.
The Pittsburgh-based organization has even broader ambitions for the use of artificial intelligence.
Highmark plans to work with Abridge to codesign an AI-powered prior authorization solution at the point of care along with other innovative tools that integrate Abridge’s AI technology, the organization said.
Highmark Health operates a multistate insurance services division, called Highmark Inc., and Allegheny Health Network (AHN), a 14-hospital care provider.
Highmark and Abridge will start testing the prior auth tool with Highmark Health members seeing an AHN clinician using Abridge's technology, said Richard Clarke, Ph.D., Highmark Health's chief analytics officer.
"We're definitely designing this in a way that we expect it to scale, both in terms of other payers at Allegheny Health Network, but also other providers beyond that," Clarke told Fierce Healthcare. "That's a core tenet of what we're doing, making sure that whatever we're doing is scalable and building upon a lot of the infrastructure that is being built."
As it looked for ambient clinical documentation partners, Highmark conducted an extensive evaluation process with a number of different AI scribe options, Clarke said. More than 500 clinicians tested out different vendors across many specialties and subspecialties.
Abridge is rapidly scaling its AI medical scribe technology and now works with more than 150 health systems. Its AI converts a patient-clinician conversation into a structured clinical note draft in real time and integrates it seamlessly into the EHR system.
The organization will roll out Abridge’s ambient clinical intelligence platform at AHN outpatient locations with plans to eventually expand across the entire health system footprint, including emergency departments, hospitalist programs and home care environments, executives said.
The use of ambient clinical note-taking enables clinicians to be more engaged with patients and is showing promise in reducing physician burnout. In its own tests of ambient scribe technologies over the last year, AHN reported that 92% of its patients felt their providers were more attentive during their visits when ambient scribe technology was being utilized.
AHN clinicians who piloted the technologies reported dramatic improvements in documentation and workflow efficiency, the organization said.
Exploring AI for 'real-time' prior auth processes
Through its collaboration with Highmark, Abridge is also expanding its AI capabilities to tackle other administrative processes like prior authorization.
The effort comes as prior auth faces increased scrutiny. Back in June, about 50 insurers, including all six of the largest, publicly traded health plans, pledged to cut red tape in the prior auth process.
"Highmark Health and AHN represent something quite rare in the industry. They are a payer-provider who's incredibly creative and innovative, and their innovations span any number of different areas, but include prior authorization," Shiv Rao, M.D., CEO of Abridge, in an interview. "They're actually one of the few entities across the country who really innovated and revolutionized what prior authorization today looks and feels like for clinicians across their whole system. It's an incredible privilege for us to be able to learn from all of their expertise in this area, but also be able to work with them creatively to apply AI into these workflows to further augment them."
Abridge developed an AI solution that automates tasks such as completing forms, submitting and reviewing requests, tracking their status and identifying when prior authorization is needed in the first place. The feature works like a real-time checklist outlining the authorization criteria for a particular medical procedure. Clinicians review all AI-generated recommendations before anything is submitted.
The company will now collaborate with Highmark to refine and test the solution with the organization's subject matter experts.
The goal is to reduce the burden of the prior auth process for clinicians and health system administrators and ensure patients get timely care, transforming what can be a weekslong process into mere minutes, Rao noted.
The future vision is a tool that allows clinicians to push through patient medical procedures and medications at the point of care, the organizations said.
An American Medical Association survey of 1,000 physicians in late 2024 found that, on average, practices complete 39 prior authorization requests per physician, per week. Physicians and their staff spend an average of 13 hours completing those requests each week.
The collaboration with Abridge builds on Highmark's ongoing work to improve the prior auth process, including its Gold Carding program that provides expedited prior auth for clinicians who adhere to evidence-based clinical guidelines.
"We've made tons of progress on improving the speed of approvals and improving the overall experience, both for clinicians and for members and patients, but we really saw what Abridge was working on allowed us to take that to the next level," Clarke said.
As an organization that operates both an insurance business and provider services, Highmark Health is in a unique position to help codesign an AI-powered prior auth tool, Clarke said.
"We are the ideal candidate to figure this out because it does require iteration. One of the biggest things that you need with iteration is trust. You need a bunch of different parties at the table that are all open and trusting, driving towards the same shared goals," he said.
Until now, most attempts at solving the challenges of prior authorization have focused on streamlining the approval process post-encounter. With Abridge, the authorization process will now happen at the point of conversation, the organizations said.
As it begins testing out the prior auth tool, Highmark will start with a specific procedure within a specialty to ensure accuracy. "Once we have confidence that we can get it right, we'll start to expand from there," he said.
Highmark can bring insights into health plan processes into the conversation between providers and members. "It's just the first of many joint development collaborations that will happen between Highmark and Abridge within this collaboration agreement. We think there are many other insights that fit within the payer's view that you can't get into that provider workflow to be acted upon and Abridge's technology will allow us to do that," Clarke said.
As providers and payers test out and implement automation and AI solutions, there are concerns that it's turning into an arms race, as each sector tries to get a leg up.
Highmark and Abridge say they are striving to use AI to "build a bridge" across payers and providers, Clarke said.
"That's always been our high-level strategic direction for the company," Rao said of Abridge. "In general, our work with Highmark and AHN demonstrates that this technology, AI, doesn't need to be an arms race. It doesn't need to be framed as agents on one side versus agents on the other. So given that it's not a zero-sum battle, when you're able to collaborate with a really innovative system like Highmark and AHN, it's just a question of how do we use tools like AI to get at system benefits and better outcomes. How do we improve the experience for clinicians? And, most importantly, how do we improve the experience as well as outcomes for their patients?"