WellPoint uses Watson to speed up pre-approval process


WellPoint, IBM and New York-based Memorial Sloan-Kettering Cancer Center have created a new product to help doctors personalize patients' treatments, streamline review processes and reduce waste.

To develop the clinical decision support tools, including one that makes Watson technology available through the cloud, WellPoint's nurses used 25,000 test case scenarios and 1,500 cases to train the supercomputer to review authorization requests for common procedures, InformationWeek Healthcare reported.

WellPoint already has begun using the Watson-based tools on a limited basis to process doctors' requests for common medical procedures for its members in Indiana, Kentucky, Ohio and Wisconsin, reported the Associated Press.

It plans to have 1,600 providers and 50 percent of its network nurses using a Watson product to determine whether certain procedures should be approved by the end of the year, according to Bloomberg. And it plans to sell the tools to other insurers, including its competitors.

Although both WellPoint and IBM officials clarified Watson wouldn't be making any actual clinical decisions, it could decrease the pre-approval process from as much as 72 hours to almost real-time. That's because utilization management nurses spend up to 60 percent of their time aggregating information before they can decide whether a request is evidence-based and complies with WellPoint medical policies, noted InformationWeek. By using the tools, the supercomputer will quickly perform that work instead.

To learn more:
- read the InformationWeek Healthcare article
- see the Associated Press article
- check out the Bloomberg article

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