Enhancing Healthcare Security: Lessons from Optum’s AI Chatbot Incident
Enhancing Healthcare Security: Lessons from Optum’s AI Chatbot Incident Author – Seshaveni Payasam The recent Optum AI chatbot security lapse – where the tool was lef
AI Agents for Healthcare
AI Agents and Agentic Workflows for Patient Engagement, RCM, Prior Auth, Patient Throughput, Staff & Block Scheduling and Supply Chain, to improve efficiencies, revenue, & reduce costs
Patient Engagement AI Agents
- Boost treatment follow-through with AI reminders.
- Help patients manage their health with personalized plans.
- Automate communication to keep patients engaged.
- Provide helpful insights to keep patients on track.
- Improve patient satisfaction with ongoing support.
Revenue Management AI Agents
- Streamline healthcare revenue management streams using AI/ML technology
- Revolutionize claims management processes for hospitals
- Enhance accuracy and efficiency in revenue cycle operations
- Automate routine tasks related to claims processing
- Provide real-time insights and alerts for financial staff
Prior Authorization AI Agents
Current Manual Process
- Repetitive
- Cumbersome
- Error Prone
- Paper patient records
- Manual interpretation of patient records
CloudAstra Optimized Process
- Automated
- AI/ML-based training. learning
- ChatGPT based explanations
- Parse records using generative AI
Competitive Market Intelligence - For Providers
- Compare your prices with top competitors
- Get access to Payer pricing and see how your competitors are getting reimbursed
- Get alerted when new competitor data is available and key prices change
- Understand how your price ranks in local, state, and national markets
- Check quality scores of your competitors along with their prices
- Build a data driven response to protect your market position with up-to-date pricing intelligence
- Run simulations on how price changes will affect revenues
Negotiate a better Employee Pricing- For Employers
- Determine what hospitals need to charge to commercial customers to break even overall using the Cloudastra platform with integrated NASHP commercial break-even calculation.
- Compare prices paid by employers as compared to prices paid by Medicare for both inpatient and outpatient care.
- Simulate savings and/or potential financial loss.
- Often, employers need the ability to simulate Medicare prices to create a benchmark. Cloudastra’s solution can assign services to case-mix groups and assign a price for each service based on the national base rate, case-mix group, hospital-specific adjustments, and other outlier adjustments. For each service, we can measure the amount Medicare would have paid for the same
CMS Compliance
- Stay compliant with CMS guidelines for transparent pricing data
- Publish validated pricing data
- Support patient portals
Contract Negotiation - For Providers & Payers
Get an advantage in Payer-Provider contract negotiations by having competitor health plan contract pricing data readily available via the Cloud Astra Transparent Pricing data.
Search by top CPT/HCPCS/DRG codes or by provider/payer to determine competitive pricing that can help during contract negotiation
Pediatric Workflows and Patient Throughput AI Agents
- Use AI/ML to optimize pediatric throughput using pediatric-specific models
- Adjust staff levels for surges including pediatric specialization
- Reduce wait times for pediatric patients and families
- Optimize patient transport requests for labs and imaging
- Communication and alerts to staff based on events and wait times
Patient Throughput Optimization AI Agents
- Use AI/ML to optimize patient experience
- Adjust staff levels for surges
- Improve patient experience
- Adjust patient journeys through labs and imaging based on wait times
- Communication and alerts to staff based on events and wait times
Resource Scheduling AI Agents
Block Scheduling
- Analyze gaps in blocks using AI
- Generative AI-based communication with provider groups
- Automation of block acceptance communication
- Analyze block usage
Staff Scheduling
- AI/ML-based analysis of past staff schedules
- Generative AI-based communication with hospital staff
- Automation of staff assignments based on schedules
Healthcare Supply Chain AI Agents
Use Analytics, AI/ML, and Generative AI
- Address Demand Variability
- Reduce Supply disruptions
- Improve Regulatory compliance
- Address Product expiration and obsolescence
- Product recalls and quality issues
Hospital Price Transparency Data Solutions
Hospital Price Transparency Data Solutions
Custom Solutions
Talk to us about the issues you need to solve and we can create ai agents that address your workflow and automation needs
The complexity of acquiring Pricing Data
A large volume of data is now available in the public marketplace, but unfortunately, it is not user-friendly or easily interpretable. We need a complex data engineering platform and data engineering experts to get value out of this data jungle.
Data accessibility is an ongoing challenge. Providers are hosting data in a different format than payers Data Quality is a concern as well. Companies are finding it extremely difficult to analyze and extract tangible insight.
The available pricing data in a silo is insufficient unless combined with healthcare billing, revenue, and cost data sets to derive meaningful insights
CloudAstra engine makes it easy
Scalable data platform to ingest, process, and store a large volume of pricing data from payers, providers, and employers.
Prebuilt models that are trained on prior data for predictive and generative AI.
Extensible data platform to include additional healthcare datasets (claims, quality, finance, cost, revenue, etc.) for complete visibility.
Weekly refreshed and curated data sets from multiple partners in an easily consumable format for analytics use cases across the healthcare network.
Comprehensive standardization and data quality check to manage data inconsistencies.
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