The Illustra solution appears to be a model wherein the Illustra staff map or translate your data into their algorithms.…
Monday Morning Update 6/23/25
Top News
Major US health insurers pledge to improve prior authorization practices. They aim for 80% real-time decisions by 2027, fewer procedures that require approval, and 90-day care continuity for patients who switch plans.
Insurer trade group AHIP says that it understands patient frustration. It did not mention mounting regulatory and political pressure.
Insurers blame half of PA delays on providers who submit requests via mail, phone, or fax. They say that they will help those providers transition to electronic submissions.
Reader Comments
From Frank: “Re: AI. Is a vendor’s platform AI-enabled just because the junior PR person used ChatGPT to write the press release?” AI-crafted announcements and lengthy punditry articles on social media – which are easily recognizable, by the way – are starting to get annoying. The AI versions are just a bit too polished, soulless, and peppered with em dashes and overly dramatic recitation of background facts that often contain hallucinations.
HIStalk Announcements and Requests
Few poll respondents think more highly of Oracle Health now than in the pre-acquisition days when it was Cerner. I ran this same poll one year ago and the numbers were identical, so at least they’re holding steady. It has been three years since EVP Mike Sicilia promised the Senate Committee on Veterans’ Affairs that it would “start over” in rewriting Cerner’s pharmacy module in 6-9 months.
New poll to your right or here: How concerned are you that AI will diminish or eliminate your job within five years? The poll results may be tricky to interpret. People who are convinced that their role requires their unique insight, nuance, or relationship skills are possibly like medical transcriptionists in failing to see what’s coming. I might get more objective responses if I instead asked if AI could eliminate the job of co-workers or direct reports. I’ll predict with admittedly superficial insight that the first health tech jobs to be affected will be prior authorization specialists, records retrieval and chart abstracting folks, RCM coders, marketing staff, and call center / help desk people.
The onset of summer means that we offer incentives for companies who can take their minds off vacations and beach weekends and make the decision to sponsor HIStalk. I don’t discount normal sponsorship cost because that wouldn’t be fair to existing sponsors, but we will usually offer one-time extra months, webinar exposure, or email messages, not to mention special offers for startups or former sponsors who rejoin the fold. Contact Lorre.
Sponsored Events and Resources
None scheduled soon. Contact Lorre to have your resource listed.
Acquisitions, Funding, Business, and Stock
Business Insider describes the “New Mountain special” for VC firms, as private equity firm New Mountain Capital is acquiring and rolling up health tech AI companies that are unlikely to IPO or be acquired. The firm operates more like a venture studio, targeting higher-risk innovation with larger investments, minimal debt, and a focus on long-term value creation. Some of its big deals involve Datavant from its acquisition of Ciox Health and its recent combination of Access Healthcare, SmarterDx, and Thoughtful AI to create RCM technology vendor Smarter Technologies.
Ohio’s attorney general conditionally approves the $485 million acquisition of Akron-based Summa Health by a business venture that is owned by VC firm General Catalyst.
Non-profit, money-losing Ascension will acquire Amsurg, which runs 250 ambulatory surgery centers in 34 states, for $3.9 billion. Bring on those facility fees.
People
SmarterDx hires Kit Kieling, MD (Orderly Health) as CMIO. He is an Air Force veteran and US Air Force Academy graduate who volunteered to serve as a pediatric ICU director for host-national children in combat field hospitals in Iraq and Afghanistan with the 332nd Expeditionary Medical Operations Squadron.
Dan Phippen (R1 RCM) joins Evergreen Healthcare Partners as chief growth officer.
AdventHealth hires Erica Williams, MBA (Ascension) as VP/divisional CIO.
Announcements and Implementations
UnitedHealthcare announces AI-powered provider search for members.
Epic summarizes some of the main points it made in its response to HHS’s RFI on health tech interoperability and infrastructure.
Humanate Digital pilots its AI front desk receptionist. The assistant checks patients in for clinic visits and adjusts its tone based on patient facial expressions. Other versions handle medical records requests and billing.
Government and Politics
Every newborn in England will have DNA screening within 10 years to allow NHS to predict and prevent disease and personalize treatment.
Other
Hartford HealthCare installs an OnMed CareStation in Bradley International Airport, the first such device to be placed in a US airport. The health system hopes to attract six patients per day to the CareStation, which accepts insurance and cash payments.
Sponsor Updates
- Healthcare IT Leaders staff volunteer at Children’s Healthcare of Atlanta.
- Capital Rx releases a new e-book titled “Why Savings Don’t Materialize: The Truth About Pharmacy Benefit Procurement.”
- Optimum Healthcare IT releases a new episode of its “Visionary Voices” podcast featuring Mike Mosquito.
- Rhapsody offers a new white paper titled “The 5 Most Common Interoperability Missteps—and How to Avoid Them.”
Blog Posts
- Why Healthcare Needs a Different Kind of SOC (Fortified Health Security)
- Rethinking the EHR: Behavioral Health at the Center of FQHC Technology (Netsmart)
- ProFee vs. Facility Coding: Key Differences, Challenges, and the Autonomous Solution (Nym)
- Reflections from Databricks Data + AI Summit 2025 (Redox)
- 5 Ways Improving Care Access for Members Is a Force Multiplier for Engagement and Outcomes (ReferWell)
- The Ultimate Guide to Cloud Payments: Features, Benefits & Real-World Applications (TrustCommerce, a Sphere company)
- What is a CVO? A Step-by-Step Guide for Successful Credentialing (Symplr)
- Tegria at the IPMI Healthcare IT Institute: Insights on Cloud-Enabled Digital Evolution (Tegria)
- SIIM 2025 | Visage’s Top Five (Visage Imaging)
- Harnessing tech to combat drug diversion (Wolters Kluwer Health)
Contacts
Mr. H, Lorre, Jenn, Dr. Jayne.
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The insurers say it’s the providers who are impeding electronic streamlining of prior auths?They must be smoking some really good stuff !
Anyone in medicine knows we’re already submitting orders and scripts electronically, so why would we want to sit on hold with the pharmacy to find out what number to call for the insurance company, sit on infinite hold with the insurer to speak to someone to get the code number to enter into Cover My Meds, answer a few questions in cover my meds about why you want to keep prescribing a cheap generic drug that the patient has been well controlled on for years, and then call the patient and pharmacy back to ask them to put through the script again when the insurer finally approves it? (Also, the insurers are the ones who want to fax you the approval even when you say you don’t have a fax machine.) It’s clear that insurers make money off approval delays and by demoralizing and burdening clinicians and patients till they just throw up their hands in disgust. And now they’re trying to paint the clinicians as the source of the problem???
From an informatics standpoint, it would be challenging to fully develop and integrate an electronic solution but only because there’s no standardization within or across insurers about pre-auth requirements and associated information requests. Since initial denials are often automatic, formal appeal letters are then needed. This would be doable electronically but adds further design complexity.
Instead, as a modest proposal, just eliminate prior authorization all together since it’s associated with huge costs (financial and clinical) that far outweigh any benefits. That would streamline processes considerably and insurers would have one less thing to mislead people about.
Re: Oracle EVP Mike Sicilia’s promise of a new Cerner pharmacy module in 6-9 months.
Ah, I see the problem here! He meant 6-9 years…
A simple mistake, anyone could make it.
I’m one of the health tech jobs mentioned. In no way is AI able to take on my actual role. But I expect to be affected because the PERCEPTION that it can replace me seems unshakeable in the job market. On a task level I’m dealing with slop all the time from people who don’t know better, and I don’t suppose they understand the macro version of my role either.
One of the dangers to the existing job market, I would say is this: AI may not be able to take on the full duties of a human doing the job. But if the AI can do the job cheaper, and can do a downrated but acceptable version of those services? I think we’ll see job replacement anyway.
This is exactly what happened during the offshore outsourcing waves of years past. The foreign services firms often didn’t do as good a job, but it was lots cheaper and domestic management found they could live with the Lo-Cost + Poor Services combo.
Never underestimate the appeal of “cheaper”.
This is likely the right answer. Big corporations are happy with lower quality but cheaper work as long as customers can’t easily switch to a competitor. Maybe that’s why they all do it at the same time.
I’m curious about the effect on computer science programs at colleges. Just as “computers” were originally humans who performed computing, will the concept of human “programmers” be a future point of trivia?
https://www.theatlantic.com/economy/archive/2025/06/computer-science-bubble-ai/683242/
Maybe right up there with webmaster, Flash developer, and prompt engineer.