Elevance Health Makes Clinical Review Faster, More Connected with Health OS

Key Terms

electronic health records (ehrs) medical

Electronic health records (EHRs) are digital versions of patients’ medical charts that collect diagnoses, medications, test results and treatment notes in a secure, searchable system — like a digital filing cabinet for a person’s health history. They matter to investors because EHR adoption affects healthcare costs, provider efficiency, regulatory compliance, data-security risk and the revenue prospects of software and service providers that build, maintain or integrate these systems.

health information exchanges technical

Health information exchanges are secure systems and networks that allow hospitals, clinics, labs, insurers and other health organizations to share patients' medical records and test results when needed, like a shared library or highway for health data. For investors, they matter because they influence how efficiently care is delivered, affect revenue and cost models for healthcare providers and tech vendors, and carry regulatory and cybersecurity risks that can change adoption and profitability.

prior authorization regulatory

Prior authorization is a process where a health insurance company requires approval before covering certain medical services or medications. It functions like a pre-approval step, ensuring that the treatment is necessary and appropriate before expenses are paid. For investors, understanding prior authorization is important because delays or denials can impact healthcare costs, provider operations, and the financial stability of related companies.

electronic prior authorization regulatory

Electronic prior authorization is a digital process that lets doctors, pharmacies and insurers exchange the paperwork needed to approve coverage for a prescription or medical service before it’s provided. By replacing phone calls and faxes with automated checks and approvals, it reduces delays and administrative costs, speeding patient access to treatment. Investors care because faster, more predictable approvals can boost drug and device uptake, shrink operational expenses, and influence revenue timing for healthcare and tech companies.

epic payer platform technical

A payer platform is the central software system used by health insurers to run membership records, process claims and payments, manage provider contracts, handle billing and customer service, and produce compliance and performance reports. Think of it like the insurer’s core banking engine and call center combined: it keeps the business running, controls costs and accuracy, and determines how quickly and reliably members get care and providers get paid. Investors watch payer platforms because upgrades or replacements affect operating efficiency, regulatory risk, contract wins, and long‑term profitability.

utilization management regulatory

Utilization management is the process health insurers and providers use to review and approve medical services, tests, and treatments to make sure they are necessary, appropriate, and cost-effective. For investors, it matters because these reviews influence how often care is paid for, affect healthcare providers’ revenues and drug or device sales, and can change costs and demand—like a gatekeeper deciding which requests move forward and which do not.

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INDIANAPOLIS--(BUSINESS WIRE)-- Elevance Health today 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.

Health OS is Elevance Health’s secure data platform designed to connect health information across electronic health records (EHRs), 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.

“Health OS represents a foundational shift in how we approach clinical review and utilization management - moving from fragmented, manual processes to a connected, intelligent ecosystem,” said Ashok Chennuru, Chief Data and Digital Transformation Officer at Elevance Health. “We are enabling faster decisions, reducing administrative burden, and improving the overall care experience by applying advanced analytics and embedding data-driven insights directly into workflows between care providers, payers, and other partners.”

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

For providers, this means reduced administrative burden and a more intuitive, streamlined experience that aligns with existing workflows. For members, it translates to faster access to approved treatments and a more predictable care journey.

“Much of the waste and complexity in healthcare could be reduced by simply making the right information available to the right stakeholders,” said Alan Hutchison, Vice President at Epic. “Through our work with Elevance Health, Epic’s Payer Platform has enabled meaningful reductions in administrative burden with measurable reductions in denials, peer-to-peer reviews, and appeals. This means less work for providers and faster access to care for patients.”

Elevance Health is focused on expanding its capabilities, advancing a future where utilization management is faster, simpler, and more aligned with patient care. Health OS reflects Elevance Health’s broader commitment to simplifying the healthcare experience for consumers and helping to improve health outcomes.

About Elevance Health

Elevance Health is a lifetime, trusted health partner whose purpose is to improve the health of humanity. The company supports consumers, families, and communities across the entire healthcare journey – connecting them to the care, support, and resources they need to lead better lives. Elevance Health’s companies serve approximately 105 million consumers through a diverse portfolio of industry-leading medical, pharmacy, behavioral, clinical, home health, and complex care solutions. For more information, please visit www.elevancehealth.com or follow us @ElevanceHealth on X and Elevance Health on LinkedIn.

View source version on businesswire.com: https://www.businesswire.com/news/home/20260623505173/en/

hieu.nguyen2@elevancehealth.com

Source: Elevance Health, Inc.