By Guest contributor |
Precision and timeliness can be a matter of life or death. That’s why the healthcare sector faces the dual challenge of improving operational efficiency while driving down costs. Organisations run on slim margins, increasing their need to use AI to find cost savings and revenue opportunities.
Four startups – Humata Health, Octagos, Outbound.ai and Raapid AI – are all helping healthcare providers and payers overcome these specific challenges. Each company brings a unique approach to using AI and agents for improving efficiency and reducing costs, and together they represent a promising vision for the future of healthcare management.
Humata Health seeks to automate the preauthorisation process for providers and payers, reducing the time spent waiting for approval and ensuring patients receive faster access to necessary treatments. Delivering completely ‘touchless’ authorisations, clinicians can use Humata Health solutions by simply entering an order for a procedure into an electronic health record (EHR) and receive prior authorisation from payers without any other human intervention.
Humata Health’s AI system integrates seamlessly with existing healthcare systems, analysing documentation and payer requirements to generate preauthorisation requests and decisions. This not only enhances efficiency for both providers and payers, but also improves the patient experience, enabling care delivery to proceed without unnecessary delays. By addressing one of the most time-consuming aspects of healthcare administration, Humata Health exemplifies how AI can transform cumbersome processes into streamlined interactions.
Meanwhile, Octagos helps healthcare organisations enhance both operational and financial efficiency. The volume of data generated by remote patient monitoring, such as patients wearing implantable and wearable cardiac devices, has created significant operational and financial strain. Most transmissions are non-actionable, requiring time-consuming manual triage, which adds to the administrative workload and delays clinical care. Octagos addresses this challenge through an AI-powered platform that combines high-accuracy data analysis with expert clinical validation. Its machine learning engine identifies meaningful cardiac events with over 94 per cent accuracy, significantly reducing unnecessary data review. Certified cardiac specialists then validate the findings, ensuring both clinical efficiency and diagnostic integrity.
For high-risk populations, such as heart failure patients, Octagos enables near-real-time transmission review, supporting proactive care strategies that can prevent hospitalisation and reduce costs. By aligning clinical efficiency with financial sustainability, Octagos exemplifies how targeted AI integration can advance both quality care and cost-effective operations.
Outbound.ai, on the other hand, is on a mission to improve the human work experienced in healthcare. Its AI agents for revenue cycle management (RCM) transforms how administrative work gets done for healthcare providers. Built on a cloud-based Applied AI platform, Outbound.ai delivers integrated, use-case specific voice AI and integrated workflow software that augment human staff to increase productivity, reduce costs and add scalable capacity.
Outbound.ai’s initial suite of AI services is focused on backend RCM, offering pretrained AI agents, software and a powerful applied AI platform that relieves medical billing teams of tedious payer phone calls, portal queries and fax related tasks that typically consume up to two-thirds of their day. With Outbound AI’s scalable capacity, customers can dramatically reduce labour cost and dependency, improve staff productivity and increase collections.
In addition, Raapid AI is helping healthcare providers to navigate complex claims processes and ensure compliance with evolving regulations. The startup has emerged as a leader in this domain, offering a solution that harnesses the power of AI to predict, identify and mitigate risks before they can escalate into costly problems.
Raapid AI’s platform analyses vast unstructured and structured datasets to uncover patterns and anomalies that may signal areas of concern and opportunity, whether related to care quality gaps, patient safety, claims inaccuracies or compliance risks. By providing actionable insights in real time, it enables healthcare stakeholders to take initiative-taking measures, reducing costly interventions and minimising liabilities.
While each of these startups addresses distinct challenges within the healthcare ecosystem, their shared reliance on AI highlights a common thread: the ability to transform inefficiency into innovation. By applying AI to areas like preauthorisation, remote monitoring, revenue management and risk mitigation, Humata Health, Octagos, Outbound.ai and Raapid AI demonstrate the far-reaching potential of technology to save money and improve outcomes. These solutions don’t just benefit healthcare providers and payers – they serve patients, ensuring that resources are allocated effectively and care is delivered promptly.
Sally Ann Frank is global lead for health and life sciences at Microsoft for Startups
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