Johns Hopkins' AI initiative to address NSA compliance

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Johns Hopkins Health Plans is wading further into the artificial intelligence waters with a partnership meant to ensure member compliance with the No Surprises Act.

By adopting InsightPro from MDI NetworX, Johns Hopkins Health Plans (JHHP) is addressing what it sees as an issue surrounding the No Surprises Act: While the law created transparency for patients and protection against unexpected billing, it also brought new compliance requirements that left many health plans "scrambling," according to Johns Hopkins.

Ryan O'Donnell, chief operating officer for Johns Hopkins Health Plans, called the technology "innovative" and said it would ensure members have accurate, up-to-date provider information, and would promote trust in the company's services.

WHAT'S THE IMPACT?

Powered by AI, the analytics platform has already yielded significant benefits for Johns Hopkins Health Plans, the company said.

For one, it has ensured timely updates to provider directories, resulting in improved transparency for patients and minimizing billing confusion, according to JHHP. It has also provided progress tracking and quality assurance capabilities to limit errors in directory listings.

The organization added that the technology has decreased claims showing incorrect member cost-shares, thereby promoting a smoother member experience and reducing member and provider abrasion.

"As a managed care organization administering government programs, compliance with laws and regulations is critical," said John Wells, executive director of compliance for Johns Hopkins Health Plans. "Technology that reduces errors and improves quality assurance makes us stronger for those we serve."

JHHP began inching into the AI payer space earlier this year when it launched a new multi-payer portal to connect providers and payers. Using the real-time, AI-driven platform, provider offices will be able to submit and track electronic claims, claims status, remittance and claims payment information, according to Johns Hopkins. It helps providers with insurance claims and prior authorization requests.

An AHIP survey released earlier this year showed that during the first nine months of 2023, the No Surprises Act protected Americans from more than 10 million surprise medical bills. 

THE LARGER TREND

Johns Hopkins Health Plans administers provider-sponsored health plans backed by the clinical research of Johns Hopkins Medicine. 

As a joint entity of the Johns Hopkins Health System and the Johns Hopkins University School of Medicine, Johns Hopkins Health Plans serves nearly 450,000 members in Maryland and the Mid-Atlantic region.

Johns Hopkins Health Plans has four health plans: the US Family Health Plan, Employer Health Programs, Priority Partners and Advantage MD. It manages more than $3 billion in annual premiums.

It also has a Solutions and Innovations venture in partnership with Johns Hopkins faculty and providers, turning research and ideas into digital products, including the population health analytics software called the Johns Hopkins ACG System.

Johns Hopkins Medicine, based in Baltimore, has six academic and community hospitals, four suburban healthcare and surgery centers, over 40 patient care locations, a home care group, and an international division.

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Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.