The U.S. healthcare system is undergoing a transformative shift as AI is being applied to nearly every aspect of administration and clinical care. Within the context of revenue cycle management (RCM), AI-driven solutions claim to streamline eligibility verification, automate claims processing, enhance coding accuracy, and improve patient payment collections. But, can vendors deliver on these promises today?

A comprehensive primer for provider organizations looking to make a technology purchase decision in the AI scribe category — covering everything from key components of a solution to best practices for evaluating vendors.

This week, Bobby spoke with Jessica Beegle, formerly of Lifepoint Health, on how the organization honed its data to be more useful to end users, as well as physicians’ experiences with “surprise and delight” in clinician-facing tools.

An outflow of nurses from the workforce in recent years—almost 100,000 retired during the pandemic —has left hospitals battling a constant staffing problem. To address this challenge, hospitals have gotten more innovative around tooling dedicated to empowering nurses and extending their impacts. This week we’re covering AI-enabled virtual nursing tools designed to help a centralized nurse or nurses manage a greater number of patients.

This week, Bobby spoke with Mark Townsend of Bon Secours Mercy Health, and Accrete, their digital holding company. They discussed BSMH’s priorities for the next year and how they reached the decision to co-develop a AI ambient scribe solution for their nurses.

In September 2024 we tracked 67 healthcare IT news stories, with AI clinician assistant , data & analytics , and clinical operations news showing up most frequently. Here, we’re summarizing the month’s news—finding the signal in the noise—so you can stay abreast of the most important trends you may have missed.

This week, we read Oscar’s claims system technical deep dive . Over several years, their team re-architected their claims infrastructure, building a standalone, monolithic platform from scratch. Here, Patrick reflects on how this will impact Oscar, and—more broadly—what it could mean for the rest of the payer claims landscape.

Particle has brought forth an antitrust lawsuit alleging anticompetitive behavior in the payer platform category. Here, we discuss with Brendan Keeler the basis for this suit and its possible implications.

While many AI vendors are developing their own models or using off-the-shelf models, there are an increasing number of innovative health systems and providers turning to LLMs in order to build critical, custom applications. Here we discuss the various types of models currently available for direct consumption by other developers.

This week, Bobby spoke with Adam Carewe of NerdMDs and former CMIO of Colorado Permanente Group. They discussed where he’s seeing novel development in the AI space, when to look outside Epic, and how leaders can better support clinicians.

Clinical pathway developers must sift through vast volumes of clinical research, expert opinions, and regulatory guidelines, converting these guidelines and protocols into discrete logical flows that can be implemented in the EHR. GenAI is reshaping how clinical pathways are developed, managed, and applied. This week we’re diving into the AI-enabled clinical pathways category.

Clinical data abstractors must navigate outdated systems, fragmented patient records, and endless PDF charts, often juggling multiple machines as they work to extract and structure data. As optical character recognition (OCR) technology has dramatically improved and large language models (LLMs) have become more adept at converting unstructured data into structured formats, automating much of this manual task has become a real possibility. This week we explore the current clinical data abstraction market.

This week, Bobby spoke with Steve West of Healthliant Ventures, a venture fund out of community health system, Tanner Health. The two discussed innovation priorities like care coordination, as well as how startups can work with community health systems.

In August 2024, we tracked nearly 80 healthcare IT news stories, with value-based care , provider and practice administration , and revenue cycle management news showing up most frequently. Here, we’re summarizing the month’s news—finding the signal in the noise—so you can stay abreast of the most important trends you may have missed.

Products in the Smart EHR UI category are taking the gamble that a customized EHR UI that incorporates AI can ultimately outperform more feature-rich EHRs in specific workflows.  This week we discuss the products in this category and what they offer compared to native workflows.

This week Bobby spoke with Justin Brueck of Endeavor Health. He discussed Endeavor’s approach to innovation, how they’re using AI now, and his priorities outside AI.

Providers have seen a 157% increase in patient messaging since COVID . Now, the question is how to use GenAI to reduce the time clinicians spend on paperwork and asynchronous communication. In this week’s market map we’re breaking down the vendors working to solve the in-basket problem.

With  clinician burnout  at an all-time high in recent years and an impending  physician shortage , health systems and software vendors are scrambling to support physicians in providing better care in less time. It follows, then, that clinician assistant products are some of the most popular AI applications we see, as measured by  deals signed, investments made , and overall product innovation.

In recent years, CMS has taken a more active role in ensuring price transparency for patients. While some implementations are on hold, it’s all but inevitable that providers will eventually be required to provide good faith estimates (GFEs) for scheduled services. This creates a new operational and technical challenge for providers looking to comply ahead of broad regulatory enforcement.

This week Bobby spoke with Keith Morse of Stanford Medicine Children’s Health. He discussed 3 AI pilots his organization is moving forward with and shared how he works to build a culture that embraces AI in his organization.

A crucial part of the payer contracting process involves competitive intelligence around pricing. While CMS requires that pricing data be published, that doesn’t mean it’s always usable. Price transparency vendors focus on both data quality and usability.

This week Bobby spoke with Daniel Guerra of ChenMed, who brought a different perspective to the tech conversation. His organization’s tight focus on outcomes and smaller panel of patients per doctor has significantly influenced their bias toward build over buy as well as where they expect to put the majority of their AI focus.

Medical licensing, while straightforward, can be time-consuming and stressful. Switching costs between vendors are low, and licensing vendors often take on this low-profit workflow to bring in new customers for higher-margin processes like credentialing. This begs the question: Will AI ever play a significant role in this market?

Credentialing is an essential step to a hospital being paid by payers. 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. Here we discuss how these solutions function now and make our educated guesses as to where the tech is headed next.

Editing and submitting claims is a complex problem, with multiple vendor categories working to get a piece of the pie. While the goal—submitting a claim with the highest chance of reimbursement at the highest rate—the process is not. Here we breakdown how the different vendors take a role and how AI is being leveraged to optimize for approvals.

In healthcare operations, a clear and accurate picture of revenue and accounts receivable can mean the difference between profitability and losing millions of dollars. Revenue intelligence products aim to bridge the data gaps between steps in the revenue cycle to create actionable insights.

Elion teamed up with Brendan Keeler of Health API guy to provide this comprehensive overview of certified EHRs. While the subject is somewhat labyrinthine, we’ve done our best to help you understand what it means to be certified and whether it truly matters.

Denials pose a major risk to provider organizations’ revenue. Here, the team discusses how AI may offer new solutions to managing payer claims denials.

AI is revamping the billing department. While tech solutions over the last five years have primarily focused on the patient engagement step, newer solutions also work to predict patient capacity to pay, offer payment plans, and may even take on collections responsibility.

Contact centers create an enormous wealth of data. Here the contact center intelligence category is discussed, including how this data can drive business decisions and how buyers can differentiate products in the category.

Vendors offering AI contact center agent assistants are discussed. Products are differentiated based on healthcare-specific workflows as well as omnichannel contact center solutions vs. standalone AI agent assistant products.

The Elion team reviews how gen AI is impacting chatbots, allowing them to be more dynamic and manage patient queries in natural language. The AI conversational chat category is described in the context of other AI contact center software.

Revenue cycle automation is discussed, including RCM-focused products and vertical-agnostic products. UI automation, API integration, and AI-enabled UI navigation are compared.

In a continued discussion of AI prior authorization vendors, this article reviews vendors that offer prior authorization AI solutions for payers.

AI-enabled prior authorization solution are emerging to reduce the administrative burden. However, products are still largely specialized, with a focus on either drugs, procedures, or other categories (e.g. DME, therapy).

Clinical documentation can be a profoundly meaningful step in driving both RCM and clinical outcomes. However, it can be time-consuming and remains imperfect. AI offers compelling improvements, and the market is described.

Medical coding is expensive, inefficient, and error-prone, not to mention challenging to staff with high team member turnover. The team discusses the strengths of AI medical coding and considerations when choosing a AI coding vendor.

Chart prep can be an enormous burden for providers who are already stretched thin. AI summarization has the potential to summarize pages of patient information into a simple digest. Here, the team discusses use cases and the potential direction of this emerging market.

We’re seeing payers get tougher when it comes to prior authorization and claims denials, which is driving more and more back-office work for providers. As such, payer-facing AI phone calls offer an opportunity for reducing overall admin workload.

Three expert healthcare operators join team Elion to shed light on how they went about building homegrown AI solutions at their respective organizations from the ground up.

Despite being inefficient, costly, and prone to errors, phone calls are still one of the main ways patients and providers communicate in healthcare. Until recently, call centers and manual phone calls were the only way to accomplish the task, but with cost overruns and an increased focus on HCAHPS, more health systems are looking at implementing AI solutions for patient-facing phone calls

AI ambient medical scribes remain a popular vendor category in healthcare. In this article we discuss the state of the ambient scribe market as of Q2 2024

Team Elion distills the insights and takeaways on practical questions related to AI adoption in healthcare sourced from first-hand discussions with 20 technology leaders across US health systems.

Three clinical leaders join team Elion to discuss the current state of AI-driven clinical documentation tools and share learnings from early experiences implementing the technology.

Revenue Cycle Management experts from organizations like Brightline, Omada Health, Doctor on Demand, and Cedar breakdown what it takes to build up an RCM function from the group up as digital health provider.

An in-depth walkthrough of headless EHRs, including a definition of "headless" and a breakdown of two headless archetypes (with sample vendors for each).

A comprehensive deep dive into EHRs in digital health, including advice for operators thinking through build vs. buy as well as a step-by-step guide on how to navigate the selection process.

Veteran operators from firsthand, Allara Health, and Frame Fertility share insights on how to navigate EHR selection as a digital health provider.

Announcing Elion's EHR vendor comparison product. Save weeks of time on vendor evaluation and make better, more confident EHR decisions with the deepest, most comprehensive EHR dataset in the market.

A crash course on working with external contact centers – how to decide when to outsource, tips on selecting and contracting with vendors, and best practices for oversight.

Advice on navigating the scaling phase, with a focus on driving operational efficiency and improving people processes.

A walkthrough of the first phase of building a contact center – setting up your initial tech stack, hiring your team, and laying the groundwork to scale.

A brief primer on contact centers in healthcare, including what they are, common types, and how to define your requirements.

The practitioner’s guide to TEFCA and QHINs – what TEFCA is, why it exists, and its practical implications (including an overview of the first six applicant QHINs).

Industry veterans from some of digital health’s most iconic companies like Oscar, Cityblock Health, & Collective Health share insights on how to build and scale contact centers.

An in-depth guide breaking down everything digital health providers need to know to develop their interoperability strategy.

Insights from product leaders at Flexpa, Redesign Health, and Medidata on the fundamentals of interoperability for digital health providers.

Hard-won lessons from experts at Oak Street, firsthand, and Pearl Health on how to build a value-based care tech stack.

Helping healthcare builders make better, faster technology decisions.