Salesforce and Blue Shield of California are launching an AI-driven system to streamline healthcare approvals, aiming to cut down prior authorization wait times from weeks to, potentially, the same day. This partnership, leveraging Salesforce’s healthcare cloud, integrates patient data to streamline approvals while retaining clinician oversight, ensuring AI decisions are always reviewed by a human expert.
Blue Shield CEO Paul Markovich emphasizes that the system is designed to avoid pitfalls seen in other AI implementations by keeping clinicians involved, especially for complex cases, and notes that this hybrid approach will help sidestep potential issues with automatic denials.
The AI will cross-reference existing coverage policies with electronic health records to confirm necessary pre-approvals, such as prior treatments or imaging scans, before greenlighting a procedure. The system’s instant data access, facilitated by California’s health information regulations, accelerates the process. Markovich likens it to the rapid authorization familiar to credit card users—seamless approvals for standard cases, with exceptions managed by human intervention.
Salesforce Industries’ Jeff Amann notes that the previous authorization process could take weeks or even a month, burdening providers with outdated technologies like fax machines. This new system is expected to bring “near real-time” processing, eliminating these outdated barriers, which will help reduce administrative strain and ensure continuity of care across diverse healthcare providers.
AI-Driven Healthcare Approvals
As the system rolls out through 2025, both companies anticipate other insurers will adopt similar AI-powered systems, marking a shift toward real-time approvals in healthcare—one in which humans remain integral to the decision-making loop, preventing “black box” rejections. Markovich sees this as a necessary evolution for the industry, stressing that technology can enhance efficiency without sacrificing the personal judgment critical to healthcare decisions.
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