When 94% of providers report care delays tied to prior authorization requirements (AMA), specialty pharmacy leaders face a defining question: how do you scale without losing high-quality patient care and the human touch?
For Shields Health Solutions, which integrates specialty pharmacy operations across nearly 80 health systems nationwide, that question naturally moved to the forefront. Built on a care model that balances clinical excellence and operational efficiency, Shields saw an opportunity to help health systems scale thoughtfully without adding staff or compromising patient care.
Technology was the obvious answer. While Shields’ connected performance platform already links health systems, clinicians, and patients, the next step was finding a technology partner that could bring advanced AI capabilities into that platform while keeping human touch at the core of what they do.
After evaluating nearly every pharmacy AI solution on the market, Shields selected Foundation Health. The framework that led to that decision, along with early results demonstrating up to 50% reduction in manual prior authorization effort, provides a practical roadmap for other health system leaders navigating AI adoption.
The Selection Framework: Three Non-negotiable Criteria
Shields approached AI adoption as an infrastructure decision rather than a software purchase. Leadership defined upfront what a long-term partner would need to deliver across a complex, multi-health system environment, centering on three non-negotiable criteria:
- Deep Specialty Pharmacy Expertise: Many AI solutions addressed isolated workflow steps rather than end-to-end specialty pharmacy operations. Shields required a partner with proven health system deployments and deep understanding of the full patient access journey.
- Workflow-Native EHR Integration: The solution had to embed directly into Epic, Cerner, and other leading EHR platforms across 80 diverse health system environments, operating inside existing clinical workflows, not alongside them.
- Partnership Structure with Shared Accountability: Beyond software licensing, Shields made a strategic investment in Foundation Health, establishing a co-development model where both organizations are aligned around long-term performance and measurable outcomes
Foundation Health emerged as the partner that best aligned with this framework, reflecting Shields’ belief that technology should enhance, not replace, the specialized expertise of pharmacy teams.
“This partnership allows us to start addressing ways AI can meaningfully optimize workflows without sacrificing the human touch that is central to our differentiated care model.” said Michael Ham, CEO of Shields Health Solutions. “Our partnership with Shields reflects a shared commitment to building durable systems that improve patient access while supporting the teams delivering care every day,” said Umar Afridi, Founder and CEO of Foundation Health.
Partnership in Practice: AI that Works Alongside Clinical Teams and Within Specialty Pharmacy Workflows
Together, Shields and Foundation Health are addressing one of specialty pharmacy’s most persistent challenges: the administrative burden and delays that slow patient access to therapy.
With the long-term roadmap extending across the entire patient access journey, the initial focus centers on prior authorization (PA) automation.
In practice, Foundation Health’s platform:
- Pulls relevant patient and clinical data directly from the EHR
- Streamlines payor specific forms and documentation
- Submits and tracks prior authorization requests
- Surfaces status updates within the systems pharmacy teams already use
By automating high-volume administrative tasks, pharmacy and clinician teams can devote more of their time to direct patient care instead of paperwork. Meanwhile, Shields and Foundation Health continue using implementation experience and performance data to refine workflows, with a shared focus on metrics such as time to therapy, denial rates and staff time spent on administrative tasks.
A New Model for AI-Enabled Specialty Pharmacy
The Shields-Foundation Health partnership demonstrates what purposeful AI adoption looks like in specialty pharmacy: grounded in workflow integration, clinical expertise, and partnership structures built around long-term performance.
For health system and pharmacy leaders, the message is clear. : As AI becomes a standard part of specialty pharmacy operations, success will depend not simply on adopting new tools, but on integrating them into existing clinical workflows at scale – all without losing the human touch at the center of care.
At the Becker's 11th Annual IT + Revenue Cycle Conference: The Future of AI & Digital Health, taking place September 14–17 in Chicago, healthcare executives and digital leaders from across the country will come together to explore how AI, interoperability, cybersecurity, and revenue cycle innovation are transforming care delivery, strengthening financial performance, and driving the next era of digital health. Apply for complimentary registration now.
