The Challenge
The client is a leading US-based medical review company focused on independent clinical and utilization reviews for health insurers, pharmacy benefit managers (PBMs), and third-party administrators (TPAs). The firm provides proactive second opinions and appropriate utilization analytics to nation’s largest health plans, helping to control costs and ensure the optimal allocation of resources.
The organization needed to build a modern decision support system to enhance the efficiency of medical decision-making, particularly in the context of patient case reviews and treatment approvals. The company challenged Persistent to quickly demonstrate a proof of concept for a system that would meet its requirements and deliver a competitive edge in the hyper-competitive healthcare market.
The Solution
Persistent recommended a Generative AI (GenAI) solution built on the Google Cloud Platform (GCP), which would ensure scalability, data security, and ease of development. The solution, designed to run on serverless technology and managed services, significantly reduced direct infrastructure costs as well as the cost of managing and maintaining that infrastructure, saving time and money for the client.
In the Persistent solution, Web-based workflows enable nurses to upload patient records and corresponding medical criteria documents, and rapidly generate a holistic Patient Summary with intelligent insights and recommendations. Responses are derived from criteria questionnaires, with a GenAI-powered backend for evaluation, integration, and prompt fine-tuning to generate real-time responses.
The Outcome
The new GCP-based application is a one-stop solution for healthcare insurers and administrators. Patient Summary outputs can now be accessed and employed by multiple departments for data analytics and cost/benefit reviews. Further, the system has greatly reduced turn-around-time; nurses can view system-generated responses and quickly validate the conclusions via a human-in-the-loop approach.
From a development perspective, the Persistent team demonstrated proof of concept in just eight weeks and currently delivering the production solution on GCP within six months — all of which accelerated the client’s progress toward measurable ROI and end-user value.
Persistent recently announced a Strategic Partnership Agreement with Google Cloud to jointly deliver market-leading solutions that help enterprises maximize the ROI from their cloud investments while modernizing their infrastructure and data stack. Contact us today for more details.
