R1 has integrated advanced AI capabilities into its Phare OS platform, leveraging two decades of expertise in healthcare revenue management. The system utilizes payor data gathered from R1’s collaborations with providers, which encompass 95 of the top 100 health systems in the U.S. According to Sam Hamamsy, this technology is built upon the knowledge of numerous coders, nurses, and auditors within R1, whose evaluations and feedback enhance the AI models.
Human oversight remains essential in ensuring the effectiveness of AI in healthcare settings. James Zou, an associate professor of biomedical data science at Stanford University, emphasizes that successful implementation hinges on expert supervision. “The ultimate guardrail is human experts who provide final oversight and carefully check some of the key results and assumptions from the agents,” Zou stated.
Streamlining the Revenue Cycle
The Phare OS platform offers significant advantages for healthcare chief financial officers and financial managers by integrating data across all stages of the revenue cycle, from patient intake to payment processing. This comprehensive approach allows providers to understand the reasons behind claim denials and helps in crafting new claims. “You can connect the dots and prevent denials instead of reacting to them,” Hamamsy noted.
Healthcare CFOs typically evaluate revenue cycle performance using metrics such as denial rates and time and cost to collect claims. Phare OS aims to enhance these outcomes by functioning as a safety net, reviewing claims before submission—an impossible task for human teams handling large volumes of data. The platform has indicated potential for over $250 in additional revenue for each inpatient discharge, with more than 40% of claim denials resolved autonomously in certain scenarios.
A regional multi-hospital system has begun utilizing Phare Audit to examine all cases prior to billing, while still maintaining its revenue cycle team to work alongside the technology. “We’re helping them surface information at the right time to the right person in the workflow and to simplify their workload so that they don’t have to review every single case,” Hamamsy explained.
Experts like Christian Terwiesch believe that AI will continue to enhance the efficiency of revenue processes in healthcare, potentially transforming claims settlement in the future. “The idea of real-time adjudication of claims is going to play out, and it will require some form of AI,” Terwiesch stated.
Currently, R1’s objective for Phare OS is to evolve revenue cycle management beyond traditional processes to achieve predictable outcomes and minimize delayed payments. “Administrative spending and the sheer burden it puts on health systems has to go down,” Hamamsy concluded. “That’s the future we’re working toward.”
