December 8, 2022

Beyond A.I. image analysis: A.I.-enhanced end-to-end utilization review workflow clinical decision support

optimizing utilization review workflow with AI and dental consultants image

A.I.-enhanced image analysis in the provider office holds potential to drive earlier prevention and treatment of oral disease, but how can dental payers best leverage A.I. technology all along a UR workflow today and see measurable process improvement?

A.I. technology continues to become more ubiquitous in the lives of people around the world. Some of its uses have enjoyed high awareness (think Amazon’s Alexa), but some of its applications are much less in the public eye. This digital revolution is becoming more apparent in the oral health industry as well. Image analysis has become the buzzy front end of the dental A.I. revolution, but the use of artificial intelligence technology can go far beyond it, with machine learning processes being embedded in the utilization review workflow for end-to-end clinical decision support. Payers who want to take advantage of the efficiency opportunities offered by this application of A.I. don’t have to wait for some future state to start reaping the benefits.

The future is now with A.I.-driven clinical decision support

A.I. will have a host of applications in dentistry over the next five years, especially in diagnostic support for providers. Many patients might even have their first experiences with A.I. during trips to their dentist. And increasingly, artificial intelligence and machine learning technology are finding use in addressing the operational efficiency needs of other organizations in the dental ecosystem, like dental payers.

One area of unmet need for payers is in integrating the next level of clinical decision support tools into their utilization review workflows. Clinical decision support (CDS) tools are meant to work with huge amounts of digital data to create operational efficiencies in suggesting next steps, delivering alerts or spotting potential problems. Today, the best CDS tools are increasingly leveraging machine learning and A.I. to power sophisticated analytics. Utilization review/utilization management processes at payer organizations are ideal places to apply an A.I.-enhanced clinical decision workflow where A.I. image technology, predictive analytics and human dental consultants come together to make the process faster and more efficient.

Achieving success in leveraging A.I. technology across the UR process

Because this is all a relatively new way of approaching utilization review for most payers, success depends greatly on finding a trusted partner who:

  1. Leverages a significant suite of standardized tools and methodology to facilitate implementation
  2. Takes a hands-on approach to support customers in this new area
  3. Provides a well-developed architecture to ensure the system is scalable and performing at the level required
  4. Has a highly-interoperable and configurable platform to support different client needs
  5. Maintains a strong, certified security posture, not only in endpoint detection and response management, but also in de-identification processes to ensure data privacy

P&R Dental Strategies has been a leader in clinical decision support tools for years with its rules-based, predictive analytics Pronto® smart claim selection engine. This is now combined with A.I. image review technology from our partner, Denti.AI, to create ProntoAI™. As a technology-enabled UR/UM clinical decision support tool, ProntoAI combines analytics, end-to-end workflow and A.I. to create workflow automation efficiencies and drive value for customers. Go beyond A.I. image review to optimize dental utilization review efficiency across the entire workflow: contact P&R Dental Strategies today.