New Orleans-based Ochsner Health has turned to automation and AI to keep pace with roughly 30% volume growth while reducing the manual workload tied to prior authorization and patient estimates.
Ochsner operates 46 hospitals and more than 370 outpatient and urgent care facilities across the Gulf South, including Louisiana, Mississippi and Alabama.
“We’ve grown significantly over the past 10 to 15 years, but even more so accelerated in the past five years,” Andre Neal, director, revenue cycle strategic partner at Ochsner, said during a panel at Becker’s 11th Annual Health IT + Digital Health + RCM Conference. “Our volumes have increased roughly 30% and we were really struggling keeping up with prior authorizations. With that increased volume, it was leading to patient care delays, frustration on the part of the physicians, the operators, and some inefficiencies on the operations side as well.”
Ochsner responded by leaning more heavily on Epic’s revenue cycle capabilities, including direct payer connections, automation for referrals that do not require prior authorization and AI tools designed to support medical necessity reviews.
About 70% of Ochsner’s commercial payer mix is connected through Epic’s payer platform, according to Mr. Neal, who has been with the health system for more than 10 years. Ochsner has also mapped roughly 50% of its referrals to Epic functionality that automatically determines when prior authorization is not required.
“As soon as the referral is scheduled, the operations team gets a notification that it’s authorized,” he said.
Ochsner is also beta testing Epic’s AI Med Necessity Assistant with about 30 employees. The tool reviews the medical record and identifies clinical information that may be needed for a medical necessity request. Employees can then select or remove records before submission.
The system has also made significant progress automating patient estimates. About 98% of its estimates are automatically generated and 62% are automatically completed, according to Mr. Neal.
“It’s been a tremendous journey of trying to combine all of these different facets. Throughout all of that we’ve saved roughly 20 FTEs in addition to absorbing all that additional volume,” he said. “Now we’re really focused on the lead time on the clinical side to make sure we can get those authorizations or a clear ‘yes’ or ‘no’ answer to our providers as quickly as possible.”
Ochsner’s strategy extends beyond Epic. When its EHR cannot provide a needed capability, the system works with outside vendors to fill the gap.
“Having a top-down, clear strategy of what we want to do and then finding the ways of using what’s available, helping push to develop what we need or going outside when needed has been crucial,” Mr. Neal said.
The health system is also focused on ensuring its automation produces accurate results. Ochsner has established small teams dedicated to managing its authorization rules and monitoring the AI medical necessity tool.
Mr. Neal said employee engagement has been another important component of the strategy. Rather than positioning automation as a way to replace staff, Ochsner has focused on shifting employees toward different work and helping longtime team members learn new skills.
“I think it’s critical to create an environment where people are excited rather than being fearful, and showing that you’re giving them something new and fun to do,” he said. “Once you get those folks engaged and give them a challenge that they feel they can contribute to, it really helps with the buy-in.”
