Highmark Health plans to implement Abridge’s ambient clinical documentation technology across its entire network, which includes 14 hospitals and hundreds of clinics.
The Pittsburgh-based health organization has even broader ambitions for artificial intelligence. It is partnering with Abridge to co-develop an AI-powered prior authorization tool for use at the point of care, along with other innovative solutions that integrate Abridge’s AI technology.
Highmark Health encompasses a multistate insurance division, Highmark Inc., and Allegheny Health Network (AHN), a 14-hospital care provider. Initial testing of the prior authorization tool will take place with Highmark Health members who see AHN clinicians using Abridge’s platform, according to Richard Clarke, Ph.D., chief analytics officer at Highmark Health.
“We’re designing this with scalability in mind, not only for other payers within Allegheny Health Network but also for providers beyond our network,” Clarke told *Fierce Healthcare*. “A core principle is ensuring what we build can scale, leveraging the infrastructure already being developed.”
In its search for an ambient clinical documentation partner, Highmark conducted a rigorous evaluation of multiple AI scribe vendors. More than 500 clinicians from various specialties and subspecialties tested different platforms before the organization selected Abridge.
Abridge, which is rapidly expanding, now works with over 150 health systems. Its AI technology converts patient-clinician conversations into structured clinical note drafts in real time, integrating seamlessly with EHR systems.
Highmark will first deploy Abridge’s ambient clinical intelligence platform at AHN outpatient locations, with plans to extend it across the entire health system, including emergency departments, hospitalist services, and home care programs, executives said.
Ambient clinical note-taking allows clinicians to focus more fully on their patients and has shown potential in easing physician burnout. In trials of ambient scribe technology over the past year, AHN found that 92% of patients felt their providers were more attentive during visits when the technology was in use.
Clinicians who participated in the pilot reported significant gains in documentation quality and workflow efficiency, according to the organization.
Exploring AI for ‘real-time’ prior auth processes
Through its partnership with Highmark, Abridge is broadening its AI capabilities to address additional administrative tasks, including prior authorization.
This initiative comes amid growing scrutiny of the prior authorization process. In June, roughly 50 insurers — including all six of the largest publicly traded health plans — committed to reducing administrative hurdles in prior auth.
“Highmark Health and AHN are truly unique in the industry — a payer-provider that’s exceptionally creative and innovative, with groundbreaking work in areas like prior authorization,” said Abridge CEO Shiv Rao, M.D., in an interview. “They’ve been among the few organizations nationwide to truly transform how prior authorization feels and functions for clinicians across their system. It’s a privilege to learn from their expertise and collaborate on applying AI to these workflows to make them even more effective.”
Abridge has created an AI-powered tool that automates key steps in the prior authorization process, including filling out forms, submitting and reviewing requests, monitoring their status, and flagging when prior authorization is required. Functioning like a real-time checklist, the system outlines the specific authorization criteria for a given medical procedure. Clinicians review all AI-generated recommendations before submission.
The company will work with Highmark’s subject matter experts to further refine and pilot the tool.
The aim is to ease the administrative load on clinicians and health system staff, while ensuring patients receive timely care — turning what can often take weeks into just minutes, Rao said.
The long-term vision is a solution that enables clinicians to approve medical procedures and prescriptions directly at the point of care, according to the organizations.
A late 2024 American Medical Association survey of 1,000 physicians found that, on average, each physician’s practice handles 39 prior authorization requests per week, with doctors and staff spending roughly 13 hours weekly on the process.
Highmark’s partnership with Abridge builds on its existing initiatives to streamline prior authorization, such as its Gold Carding program, which speeds up approvals for clinicians who follow evidence-based clinical guidelines.
“We’ve made significant progress in accelerating approvals and enhancing the overall experience for clinicians, members, and patients, but what Abridge is developing takes that to the next level,” said Richard Clarke, Ph.D., Highmark Health’s chief analytics officer.
As both an insurer and a provider, Highmark Health is uniquely positioned to help co-design an AI-powered prior authorization tool, Clarke noted. “We’re the ideal candidate to figure this out because it requires iteration — and iteration requires trust. You need multiple stakeholders at the table, all open, trusting, and aligned on the same goals,” he said.
Traditionally, efforts to improve prior authorization have focused on speeding up approvals after the patient encounter. With Abridge, the process will begin during the patient-provider conversation itself, the organizations said.
Highmark plans to start testing the tool with a specific procedure in one specialty to ensure accuracy before expanding. “Once we have confidence we can get it right, we’ll grow from there,” Clarke said.
The company also aims to bring payer-side insights directly into provider-patient conversations. “This is just the first of many joint development projects between Highmark and Abridge under this collaboration. We see many opportunities to bring payer insights into provider workflows, and Abridge’s technology makes that possible,” Clarke added.
Some in the industry worry that AI and automation are fueling an arms race between payers and providers, as each side seeks an advantage. Highmark and Abridge, however, say their approach is different — using AI to “build a bridge” between the two.
“That’s always been our strategic direction,” said Abridge CEO Shiv Rao, M.D. “Our work with Highmark and AHN shows that AI doesn’t have to be an arms race. It’s not about agents on opposing sides. When you collaborate with an innovative system like Highmark and AHN, the focus becomes how to use AI to deliver system-wide benefits, improve clinician experiences, and, most importantly, enhance both the experience and outcomes for patients.”
