JPM25, Day 1: CHAI Launches Working Group on AI for Prior Authorization

The working group will bring together health plans, health systems, and patient advocates to explore best practices for integrating AI into prior authorization.

The Coalition for Health AI (CHAI) has launched a working group to address the use of artificial intelligence (AI) in prior authorization processes.

The working group will bring together health plans, health systems, and patient advocates to explore best practices for integrating AI into prior authorization. This initiative is designed to increase transparency in a process often criticized for its opaqueness.

Brian Anderson, CEO of CHAI, said, "This is an area where there's been a lot of tension and concern about the opaqueness about how prior auth works, so shedding some light and transparency on how payers and health systems agree on going about the prior auth process using AI, or where not to use AI, I think is an exciting moment."

Anderson emphasized that creating an agreed-upon framework is crucial for industry stakeholders and patient advocates, and while progress might take time, the goal is a consensus on best practices.

CHAI aims to provide a comprehensive framework and develop a national network of independent assurance labs to ensure quality assurance and ethical standards in healthcare AI.

"It's probably going to take us six months or so to get the first draft out, but doing it transparently and ensuring that the stakeholders have a path to adopting it and using it is going to be important," Anderson said.

IU Health Focuses on Team Culture Amidst Labor Challenges

Indiana University Health (IU Health) prioritizes employee satisfaction as a key driver of its organizational growth and quality improvement efforts.

CEO Dennis Murphy outlined the health system’s initiatives to create a more supportive work environment, particularly in a competitive labor market.

Murphy highlighted that IU Health offers competitive benefits to attract and retain talent in response to the current labor shortage, including a living wage and childcare financial support.

Additionally, the health system is addressing management structure by reducing layers of management and expanding employee responsibility.

“What we said is, if you're a talented caregiver or talented in it, we want you to stay in those roles,” Murphy explained.

The focus on workforce satisfaction also includes aligning health outcomes with team performance, aiming to improve care delivery by engaging staff in preventive care and other health metrics.

"Job architecture has been really important because, in most organizations, the only way you can succeed is to become management," Murphy added.

Intermountain Health Plans New Children’s Hospital in Las Vegas

Intermountain Health is moving forward with plans to build a stand-alone pediatric hospital in Las Vegas, aiming to address the region's longstanding need for dedicated children’s healthcare facilities.

This new hospital will be the first of its kind in the area and is expected to meet the needs of the 500,000 children living in the region.

Clay Ashdown, Intermountain’s Chief Financial Officer, said, “Las Vegas is the largest metro area in the U.S. without its own dedicated stand-alone pediatric hospital. We are coming in to address that need. It’s frankly long overdue.”

The new hospital, to be built at UNLV’s Harry Reid Research and Technology Park, will provide comprehensive pediatric care services, including emergency visits, surgeries, and outpatient visits.

Rob Allen, CEO of Intermountain Health, also noted, "Pediatrics is a new angle for us. [Las Vegas] is a place now that we would consider a part of the important work we do in the interior West." The health system anticipates a significant impact on the local community, where many children travel out of state for specialized care.

Waystar Introduces AI-Driven Claims Appeal Tool

Waystar, a healthcare payment software provider, has introduced AltitudeAI, a set of AI-driven tools to simplify claims processes. A new generative AI feature within this platform will automate the process of appealing denied claims, streamlining healthcare providers' workflow.

CEO Matt Hawkins commented on the challenges providers face, said, "More than half of denied claims ultimately get overturned, but the appeal process is time-consuming, complex, and error-prone for providers."

Waystar’s new tool aims to speed up the appeals process, enabling more accurate and efficient resolutions for denied claims.

“Generative AI unlocks a new era of productivity and precision, transforming how the industry simplifies claims, appeals, and payment workflows,” Hawkins added.

ConcertAI Unveils New AI Tools for Oncology

ConcertAI, a leader in AI solutions for oncology, has announced the launch of new data and AI products aimed at improving clinical trials and patient care.

Their new offerings, including the Precision360 and Precision Insights Suite, are designed to support life sciences and healthcare providers with advanced analytics for patient journeys and clinical development.

CEO Jeff Elton said, “Our products are evolving from highly specialized solutions for experts to enterprise-level AI SaaS and DaaS solutions.”

These tools are part of a broader effort to provide real-world data insights and improve patient outcomes across oncology care. The company’s focus on leveraging AI to enhance clinical trials and patient actions further positions it as a key player in healthcare AI.