LLM-driven Startups

There are a lot of workflows in a healthcare organization that depend on manual back and forth of papers, faxes, phone calls. Multi-modal agents focused on logistical use cases can definitely reduce the workforce needed and even make overall efficiency gains (since they can parallel-process calls, navigate IVR, score calls by hold times, understand bad responses, deduce policies, escalate if needed, create call summaries, etc). Yes, they need to be integrated with the incumbent EHRs in large organizations. But for smaller, independent deployments I can see these offerings can actually be a wedge that ends up creating a master system that EHRs are subservient to.

1. Scheduling: No-shows, cancellations, reminders, changes. Multimodal agents can help everywhere. Esp. in outpatient settings.
2. Billing: Clinical documentation improvement (CDI). Mapping to medical coding systems (like ICD, CPT, HCPCS etc) so the most viable claims can be submitted for payment. Payer compliance is another dimension — payers have a lot of policies, regulations and they change frequently.
3. Banal communications: Collecting insurance information from patients, managing requests for letters of medical necessity.
4. Special Communications: Verifying benefits with payers for high-stakes treatments, prior authorizations (the poster child for LLM-based automation — costs the average physician practice nearly two business days a week), formulary inquiries and submitting exceptions.

Gen AI agents have a never-before fluent ability to have conversations and that can be used to support care delivery (for now, mostly in non-clinical contexts). No company is claiming anything that can be construed to replace a clinician, of course. But these use cases need awareness of care pathway — and this context makes them different from the operationally-focused use cases.

1. Clinician's Scribe: Creating valid clinical documentation from clinician-patient conversation is the poster child for this category. Post-LLM gold rush is happening with players like Abridge.
2. Medical Record Summarization: Visit summaries for patients, TLDR case summaries for clinicians, discharge summaries.
3. Prioritized Inbox: With patient panels of 2000+, physicians can use help in figuring out which emails to answer and how to answer them.
4. Referrals: They are the highways of healthcare, controlling revenue-generating traffic (mostly from PCPs to specialists). Lots of context-specific formal content, inter-facility communication, scheduling, confirmation, reminder, followups.
5. Conversational guidance: A co-pilot for having more successful phone calls with patients. This becomes especially powerful if the business logic gets embedded in creating the guidance output.
6. Post-op check-ins: Starts getting complicated fast, but bold PR from companies like Hippocratic AI keeps intriguing.