The gen AI helping Aetna review millions of medical records
“Now we’ve gone through 14 million documents,” Franks says. “We’re seeing a reduction of manual effort, which is now being transitioned into other areas like quality control and making sure the automated chart review is working as expected.”
Behind the curtain
Using gen AI, the platform automatically ingests and analyzes unstructured medical records and clinical documents. And as part of that process, it identifies and extracts clinically relevant information for specific HEDIS measures like diagnosis codes, medication records, lab results, and visit documentation. With this data, the platform generates a prioritized set of records based on the likelihood of measure closure and strength of clinical evidence, which is then passed to human employees for review and validation.
Frank says the platform has increased gap closure rates (leading to improved Star Ratings and higher reimbursement), streamlined workflows, and enabled teams once dedicated to manual record review to shift focus to higher-value activities.
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