Elevance Health Launches Health OS to Enhance Clinical Review Efficiency
Elevance Health announced advancements in how it helps streamline clinical review and create a simpler, faster, and more connected experience for care providers and members through Health OS. The company said, "Health OS is Elevance Health's secure data platform designed to connect health information across electronic health records, labs, and health information exchanges, helping support more informed and timely clinical decisions while reducing administrative burden for care providers. By connecting with healthcare data systems, including Epic's Payer Platform, Health OS helps reduce manual steps and deliver clearer clinical insights. Elevance Health was the first to collaborate with Epic in leveraging the Epic Payer Platform in addressing inpatient concurrent reviews, where payers and providers work together to review care plans during a patient's hospital stay. These reviews help support appropriate treatment and length-of-stay decisions but have historically relied on manual submission of clinical documentation, often resulting in delays, incomplete information, and additional administrative work. Early results from health systems using Health OS-enabled workflows demonstrate meaningful improvements: A 61% reduction in prior authorization denials due to insufficient clinical information; Nearly 60% fewer cases designated pending because of the need for additional information; Up to a 51% reduction in follow-up reviews, including appeals and peer-to-peer discussions, driven by more complete information upfront; Approximately 15 minutes of administrative time saved per case with some health systems; Care providers report a more transparent and efficient process, with fewer documentation requests, faster alignment on care decisions, and more time to focus on patient care. Health OS is also transforming prior authorization through electronic prior authorization for medical services by making it part of provider workflows and allowing information to be appropriately and securely shared back and forth between providers and the health plan. This significantly reduces reliance on phone, fax, and paper submissions, while improving speed and consistency. With more than 30 health systems actively participating in Elevance Health's program for electronic prior authorization for medical services, results highlight the impact of this approach: More than 250,000 prior authorization requests for medical services processed in 2026 through end of April; Of these, more than 42% of decisions completed in one minute or less."
