Press Release• Oct 17, 2025 08:45 EDT
GenHealth.ai and Guidehealth achieved up to a 60% reduction in Utilization Management workload using GenHealth's AI-native platform, leading to $1.2M in annual savings. The system automates clinical data extraction and policy evaluations, improving efficiency, compliance, and decision consistency above 90%. BOSTON, October 17, 2025 (Newswire.com)        - GenHealth.ai , a leader in AI-native healthcare automation, today announced the successful deployment of its AI-driven Utilization Management (UM) and Prior Authorization (PA) platform with Guidehealth , an At Risk Managed Services Organization (MSO). The collaboration resulted in up to 60% reduction in UM workload across multiple care settings, significantly improving efficiency, compliance, and an estimated annual cost savings of $1.2m. GenHealth's AI-native UM platform integrates seamlessly with existing medical guidelines, administrative policies, and provider portals to automate data intake, escalation logic, and decision recommendations-without disrupting existing workflows. During the initial pilot nearly thousands of cases were processed in 4 months before further expansion. "Healthcare utilization management has long been constrained by manual review and fragmented workflows," said Ethan Siegel, Co-Founder of GenHealth.ai . "Our work with Guidehealth proves that AI can dramatically streamline these processes while maintaining trust, transparency, and full regulatory compliance." Transforming Utilization Management with Human-Centered AI
GenHealth's solution leverages Large Language Models (LLMs) and predictive algorithms to interpret and apply complex medical and administrative policies. The system automatically extracts, summarizes, and structures clinical data from PDFs, faxes, and call center transcripts-reducing RN manual review time by an average of one hour per Skilled Nursing Facility (SNF) case and accelerating medical policy evaluations to under ten minutes per case. Each AI-generated recommendation includes detailed citations for every decision step, ensuring complete auditability and compliance with CMS, NCQA, and state-level regulations. Key Results and Impact

GenHealth.ai and Guidehealth Achieve Up to 60% Reduction in Utilization Management Workload Through AI-Native Platform

GenHealth.ai and Guidehealth Achieve Up to 60% Reduction in Utilization Management Workload Through AI-Native Platform
GenHealth.ai and Guidehealth achieved up to a 60% reduction in Utilization Management workload using GenHealth's AI-native platform, leading to $1.2M in annual savings. The system automates clinical data extraction and policy evaluations, improving efficiency, compliance, and decision consistency above 90%. BOSTON, MA / ACCESS Newswire / October 17, 2025 / GenHealth.ai , a leader in AI-native healthcare automation, today announced the successful deployment of its AI-driven Utilization Management (UM) and Prior Authorization (PA) platform with Guidehealth , an At Risk Managed Services Organization (MSO). The collaboration resulted in up to 60% reduction in UM workload across multiple care settings, significantly improving efficiency, compliance, and an estimated annual cost savings of $1.2m. GenHealth.ai x Guidehealth
GenHealth's AI-native UM platform integrates seamlessly with existing medical guidelines, administrative policies, and provider portals to automate data intake, escalation logic, and decision recommendations-without disrupting existing workflows. During the initial pilot nearly thousands of cases were processed in 4 months before further expansion. "Healthcare utilization management has long been constrained by manual review and fragmented workflows," said Ethan Siegel, Co-Founder of GenHealth.ai . "Our work with Guidehealth proves that AI can dramatically streamline these processes while maintaining trust, transparency, and full regulatory compliance." Transforming Utilization Management with Human-Centered AI
GenHealth's solution leverages Large Language Models (LLMs) and predictive algorithms to interpret and apply complex medical and administrative policies. The system automatically extracts, summarizes, and structures clinical data from PDFs, faxes, and call center transcripts-reducing RN manual review time by an average of one hour per Skilled Nursing Facility (SNF) case and accelerating medical policy evaluations to under ten minutes per case. Each AI-generated recommendation includes detailed citations for every decision step, ensuring complete auditability and compliance with CMS, NCQA, and state-level regulations. Key Results and Impact

Back to Healio
We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com . Back to Healio
Key takeaways:
An AI voice-based agent was used to talk with patients and help them collect live home BP measurements. Integrating AI into the clinical workflow reduced costs and improved care management for patients. An AI voice-based agent helped older adults with hypertension report their home blood pressure measurements, resulting in improved accuracy and high patient satisfaction, researchers reported. The findings were presented at the American Heart Association’s Hypertension Scientific Sessions. An AI voice-based agent was used to talk with patients and help them collect live home BP measurements. Image: Adobe Stock
Tina-Ann K. Thompson, MD, MBA, FAAFP, executive director of the Emory Healthcare Population Health Collaborative and division director of family medicine at Emory University School of Medicine, and colleagues evaluated whether an AI voice-based agent, in place of a phone call with a health care professional, could improve self-reported home BP measurements from older adults. Tina-Ann K. Thompson
“Patients need to be cared for outside of the four walls of our clinics,” Thompson told Healio. In collaboration with Guidehealth, a digital health care company, Thompson and colleagues used electronic health records to identify 2,000 older adults (mean age, 72 years; 61% women) with missing BP data or BP levels outside the normal range. Those patients then received calls from an AI voice-based agent, which generates live, conversational speech in multiple languages, including English and Spanish. During the call, the AI agent would talk with patients and help them collect live BP measurements or recent BP readings. After the call, the readings were entered into the EHR for clinician review. If a patient reported BP outside the normal range or symptoms such as dizziness, blurred vision or chest pain, the AI agent would send an accelerated referral to a nurse or medical assistant — either immediately or within 24 hours depending on the severity of the issue. The study’s primary endpoint was measured based on the Medicare Advantage (MA) Stars score, a 5-point rating system developed by the CMS to grade Medicare Advantage (Part C) and prescription drug (Part D) plans on certain measures, including BP control. An outreach call would be considered successful if they met MA Stars compliance. During the 10-week trial, the AI agent successfully reached 85% of patients; 67% of patients completed the call and 60% reported a live BP measurement during the call. Sixty-eight percent of patients met Stars compliance thresholds, according to the results. The researchers reported the closure of 1,939 BP gaps — reflected by moving from a 1-star to 4-star MA Stars rating — for a 17% absolute improvement. Further, patient satisfaction was very positive for the AI agent, according to the researchers. The average satisfaction score surpassed 9 out of 10. “We were surprised by how many people were willing to engage,” Thompson said. “Clinicians should consider that patients are willing to respond to multiple modes of communication.”
Further, the AI agents also helped to reduce costs and clinical burden, with each live BP reading costing 88.7% less than the traditional outreach. Thompson said future research should continue to explore the efficacy of AI voice-based agents, as it may be help to close gaps in underserved populations. “Care interventions can and should happen in-between visits,” she added. “We just need to make sure that we keep it within the scope of what it should be doing.”
Reference:
AI helped older adults report accurate blood pressure readings at home. https://newsroom.heart.org/news/ai-helped-older-adults-report-accurate-blood-pressure-readings-at-home . Published Sep. 7, 2025. Accessed Sep. 9, 2025. For more information:

AI helps older adults manage their blood pressure at home

By  Anthony Vecchione  | September 8, 2025  | 3:24 PM  AI patient engagement platform Hello Patient announced a $22.5 million Series A financing round led by Scale Venture Partners  8VC Bling Capital , Max Ventures, Remus Capital and FirstLook Partners participated in the round.  WHAT IT DOES  Hello Patient is a scheduling system that offers an application programming interface connection to electronic health records, customer relationship management and practice management systems for context across services, providers and schedules.  The AI assistant is available 24/7, answering calls and texts anytime.  In addition, Hello Patient handles medication adherence, insurance verification, patient retention and engagement, enrollment and intake.  The product targets specialty practices, including dentistry, dermatology, ENT, optometry, orthopedics, urgent care, pediatrics, primary care and veterinary.  Hello Patient will use the funds to boost its product capabilities and enhance its presence in healthcare organizations.  "With conversational AI, we finally have another, 10x better solution," Alex Cohen, CEO and founder of Hello Patient, said in a statement.  "AI that can have full conversations with patients across phone calls and SMS is giving providers the ability to deliver the seamless, responsive access experience patients expect, while also improving their bottom line."  MARKET SNAPSHOT  Other companies involved in patient scheduling and patient engagement include Guidehealth , which in June announced it received a $10 million strategic investment from Georgia-based academic health system Emory Healthcare  The platform also offers virtual health guides for patients and providers, as well as community connection and engagement and workflow-focused tools.  In January, Guardian Life Insurance Company of America joined forces with Uber Health to allow Guardian Group Benefits members with an approved long-term disability claim to receive an Uber voucher for rides to medical appointments or rehabilitation services.  In 2024, Commure acquired digital care navigation platform Memora Health . The aim of the alliance was to integrate Memora's patient navigation tools with CommureOS's proprietary integration engine  The combined platform allowed healthcare organizations to individualize patient care pathways and drive improved clinical and operational outcomes.  Additionally, Memora reinforced Commure's existing AI-powered portfolio of patient engagement, clinical documentation, revenue cycle management and real-time location systems offerings.  In 2023, GE HealthCare codeveloped an AI algorithm with Mass General Brigham to help with scheduling predictions, including failure to show up to appointments, neglecting to schedule follow-up appointments and predicting late arrivals.  In 2021, patient communication and scheduling company Luma Health raised $130 million in a Series C funding round led by FTV Capital, bringing its total raise to $160 million.

Hello Patient raises $22.5M to expand patient engagement offerings

DALLAS, TX, AND CHICAGO, IL, UNITED STATES, September 4, 2025 / EINPresswire.com / -- Guidehealth MSO, a pioneer in quality outcomes and value-based care innovation, today announced it has earned a full three-year accreditation from the Utilization Review Accreditation Commission (URAC) in Health Utilization Management. By achieving this status, Guidehealth has demonstrated its active and ongoing commitment to quality care, enhanced processes, patient safety, and improved outcomes. Guidehealth's comprehensive Health Utilization Management program has provided high-quality utilization management and review for its clients and their patients for more than two decades.  URAC is the independent leader in promoting health care quality by setting high standards for clinical practice, consumer protections, performance measurement, operations infrastructure, and risk management. Accredited organizations adhere to evidence-based quality improvement guidelines that enhance care delivery, protect patient safety, and optimize operational efficiencies while providing unbiased medical necessity and benefit coverage determinations.  “Health care professionals know that utilization management is an important component to ensure that patients receive the most appropriate care for their particular needs. URAC's Health Utilization Management Accreditation is a demonstration of excellence in reviewer qualifications, efficient timelines, appeals, and drug utilization management. We are proud to recognize Guidehealth for achieving URAC's Health Utilization Management Accreditation,” said URAC's President and CEO Shawn Griffin, MD.  “At Guidehealth, our vision is to make great health care affordable for all, leveraging technology, empathy, and trust. We earn that trust by holding ourselves to the highest standards of quality, compliance, and accountability,” said Guidehealth President and Chief Operating Officer, Mark Selna, MD. “That's why we pursued accreditation for health utilization management with URAC, one of the most rigorous, nationally recognized bodies in healthcare.”  “Meeting URAC standards is not just a checkbox exercise for us. It reflects our continual commitment to strong governance, patient-centered care, transparent operations, and continuous improvement. It also positions us to expand our capabilities in value-based care, payer contracting, and national quality programs,” said Guidehealth Chief Health Officer, McKay Crowley, MD. “Our frontline teams, managers, directors, and cross functional departments supporting our utilization management programs perform high-quality work every day, and this accreditation is a testament to their commitment.”  About URAC  Founded in 1990 as a non-profit organization, URAC is the independent leader in promoting health care quality and patient safety through renowned accreditation programs. URAC develops its evidence-based standards in collaboration with a wide array of stakeholders and industry experts. The company's portfolio of accreditation and certification programs spans the health care industry, addressing health equity, workplace mental health, health care management and operations, pharmacies, telehealth, health plans, medical practices, and more. URAC accreditation is a symbol of excellence for organizations to showcase their validated commitment to quality and accountability. www.urac.org  About Guidehealth  Guidehealth is dedicated to making great healthcare affordable for all. The company partners with payors, health systems, and clinical networks to bring scale and predictable performance to administrative services and value-based care across all lines of business. Led by physicians, Guidehealth augments existing primary care capacity using innovative AI-based protocols, remotely embedded Healthguides™, and a meticulously designed framework to predict those patients most in need of support in and beyond the exam room. www.guidehealth.com  Media Inquiries  Guidehealth  press@guidehealth.com  Visit us on social media:  LinkedIn  Legal Disclaimer:  EIN Presswire provides this news content "as is" without warranty of any kind. We do not accept any responsibility or liability for the accuracy, content, images, videos, licenses, completeness, legality, or reliability of the information contained in this article. If you have any complaints or copyright issues related to this article, kindly contact the author above.

Guidehealth Earns URAC Accreditation in Health Utilization Management

Firstsource is a business process management (BPM) partner that offers services in customer experience management, back-office operations, IT services, digital platforms, consulting, collections, and trust and safety operations. The company utilizes technologies like AI and analytics and serves sectors such as banking and financial services, healthcare, communications, media, technology, and government. Firstsource was formerly known as ICICI InfoTech. It was founded in 2001 and is based in Mumbai, India.

Firstsource

Venkatgiri Vandali , Head , Healthcare , Firstsource , shared , `` This partnership marks a pivotal step in our mission to redefine healthcare operations .

Firstsource and Guidehealth Partner to Accelerate AI-Enabled Value-Based Care Innovation for Health Plans

Koda Health provides a service focused on advance care planning within the healthcare sector. The company offers a cloud-based platform for serious illness care planning, integrated with EMR systems, and includes support from in-house staff for high-risk patients. Its services aim to assist healthcare organizations in advance care planning. It was founded in 2020 and is based in Houston, Texas.

Koda Health

Emory Healthcare operates within the medical services industry and provides hospital care, medical clinics, and urgent care facilities, as well as treatments in 70 medical subspecialties. Emory Healthcare serves patients in need of medical treatment and care. It was founded in 1905 and is based in Atlanta, Georgia.

Emory Healthcare

Story Health is a company that provides a platform and services for specialty care delivery within the healthcare sector. The company extends care beyond traditional clinical settings and focuses on patient engagement, medication management, and health outcomes. Story Health serves health systems, payors, and patients, specifically in cardiology-related services. It was founded in 2020 and is based in Cupertino, California. In September 2025, Story Health was acquired by Innovaccer.

Story Health

PA Clinical Network is a clinically integrated network focused on supporting independent physicians and improving healthcare quality. The company provides a platform for member physicians to access health insurer agreements, quality improvement resources, educational materials, and practice management assistance, all aimed at enhancing patient care and reducing costs. The network primarily serves the healthcare industry, offering services that promote physician autonomy while leveraging the benefits of a collaborative network. It was founded in 2019 and is based in Mechanicsburg, Pennsylvania.

PA Clinical Network

UpStream Care

Southwestern Health Resources

Geisinger

Northwell Health

Montefiore Health System

Digital Health 50: The most promising digital health startups of 2025

The digital health collection includes vendors developing software, platforms, sensor & robotic hardware, health data infrastructure, and tech-enabled services in healthcare. The list excludes pureplay pharma/biopharma, sequencing instruments, gene editing, and assistive tech.

Digital Health

Artificial Intelligence (AI)

Digital Health 50

Seed

Corporate Minority

Guidehealth focuses on value-based care within the healthcare industry. The company offers solutions that address patient care needs, provides Healthguides to support primary care physicians, and offers administrative services to improve healthcare delivery and operational efficiency. Guidehealth primarily serves health systems and clinical networks aiming to enhance patient engagement, population health, and financial outcomes. It was founded in 2023 and is based in Dallas, Texas.

Name	Work History	Title	Status
Sanjay Doddamani	UpStream Care, Southwestern Health Resources, Geisinger, Northwell Health, and Montefiore Health System	Founder, Chief Executive Officer	Current
Subscribe to see more	Subscribe to see more	Subscribe to see more	Subscribe to see more
Subscribe to see more	Subscribe to see more	Subscribe to see more	Subscribe to see more
Subscribe to see more	Subscribe to see more	Subscribe to see more	Subscribe to see more
Subscribe to see more	Subscribe to see more	Subscribe to see more	Subscribe to see more

Name	Sanjay Doddamani	Subscribe to see more	Subscribe to see more	Subscribe to see more	Subscribe to see more
Work History	UpStream Care, Southwestern Health Resources, Geisinger, Northwell Health, and Montefiore Health System	Subscribe to see more	Subscribe to see more	Subscribe to see more	Subscribe to see more
Title	Founder, Chief Executive Officer	Subscribe to see more	Subscribe to see more	Subscribe to see more	Subscribe to see more
Status	Current	Subscribe to see more	Subscribe to see more	Subscribe to see more	Subscribe to see more

How VCs Use CB Insights

Professional Services

Platform Overview

Guidehealth

Executives

Guidehealth Management Team

6 Team Members