Just over a year after partnering with another company to create the largest integrated prior authorization network in the industry, Jacksonville-based Availity has leaned even more into using artificial intelligence to get payer's sign-off on procedures.
The First Coast health tech company has acquired Olive AI's utilization management service and business unit, it said Monday. As part of the deal, it will take over the contracts Olive has with clients and hire employees dedicated to the utilization management business.
“We saw a clear opportunity to acquire an automated, digital solution to one of the costliest and most manually driven workflows in healthcare — authorizations,” Availity CEO Russ Thomas said in a statement. “This technology perfectly aligns with Availity’s vision of delivering omni-channel, multi-payer solutions to a fragmented healthcare data ecosystem."
Availity was founded in 2001 as a joint venture between Florida Blue and Humana, with the goal of connecting health care providers and insurers. The company is now partially owned by Novo Holdings, a health and medical technology focused investment fund.
Since Novo's investment in 2021, the company has made several acquisitions and partnerships, including a strategic partnership with PriorAuthNow of Columbus designed to speed up the process of getting insurer sign-off on authorizations for hospital procedures and prescriptions in early 2022. Later last year, Availity acquired Diameter Health, which standardizes, de-duplicates and structures clinical data, which is used in making those decisions.
The Olive acquisition adds another tool to the mix.
The system evaluates clinical data and matches it with an insurer's authorization guidelines, with the system telling a doctor if the prior authorization request meets requirements — sometimes in seconds.
Among the users of Olive's technology is Jacksonville-based Florida Blue, which said last year that it was the first U.S. payer to automate prior authorization approval through AI-powered clinical review. In a pilot program, the insurer said, the technology cut 10 days out of the amount of time it took authorization decisions to be made.
Although Olive has been a leader in the industry, it said earlier this year it was spinning off the utilization management service, letting it focus on providing automated revenue cycle solutions for health systems. After growing rapidly for several years – and attaining "unicorn" status with a $4 billion valuation — the Columbus, Ohio-based business last year laid off hundreds of employees amidst a refocusing.
"In our current position, we cannot make the necessary investments to be successful in transforming both Autonomous Revenue Cycle and Utilization Management journeys for our customers," CEO Sean Lane said in a memo reported on by Columbus Business First, a sister publication. "We must prioritize and direct our critical resources toward Olive’s established strengths."
