Using AI to Reduce Administrative Burden on Providers: Elevance Health's Shane Hochradel

Shane Hochradel, chief operating officer of Health Solutions at Elevance Health, explains that reducing administrative burden is a central principle guiding how the company listens to, measures, and responds to provider needs, because when providers spend less time on paperwork, patients receive better care.

To track provider sentiment, Elevance uses a layered approach combining real-time transactional surveys, which are triggered after key interactions like prior authorization requests or onboarding milestones, with longer-term enterprise-level measurement tools. Last year, the company launched 2 new enterprise surveys: a twice-annual competitive brand survey that benchmarks performance against peers and a quarterly relational survey designed to capture ongoing partnership insights.

This transcript was lightly edited.

AJMC: Tracking—and maximizing—provider satisfaction differentiates Elevance Health. How do you track what is most valuable to providers and enhance data reporting?

At Elevance Health, listening to the voices of care providers is central to our purpose of improving the health of humanity. Care providers are the front door to how the health care system works, and their experience directly shapes how members experience care—whether that's timely access, continuity, or outcomes. Our focus is straightforward: reduce administrative burden, so care providers can spend more time caring for patients. That principle guides how we listen, how we measure, and how we act. We use a layered care provider listing approach that blends real-time operational feedback with longer-term relationship insights. Transactional surveys capture feedback after key interactions, such as prior authorization requests or onboarding milestones, so we can quickly identify points of friction in parallel. Our enterprise-level measurement ecosystems help us understand broader sentiment, trust, and confidence over time.

This year, we strengthened that approach by launching 2 new enterprise surveys: a twice-annual, blinded competitive brand survey, which allows us to benchmark performance against peers, and a quarterly relational survey. The second one is designed to capture ongoing relationship and partnership insights. These tools generate highly actionable data, and in our most recent competitive brand survey, we saw meaningful gains in areas where we've been deliberately focused on improving the care provider experience. In several cases, we saw significant improvements. Examples are we saw an 8-point increase for prior authorization clarity. We saw a 7-point increase for digital tools and technology among clinicians. Among office staff, we saw a 19-point increase for collaboration, 15 points for digital tools, and 14 Points for innovation and leadership. In practical terms, these improvements translate to fewer follow-up calls, clear expectations, less rework for staff, and faster decisions for members awaiting care. Importantly, we've reinforced accountability in our organization by tying a care provider experience metric directly to our annual incentive plan—that linkage ensures improving the care provider experience is not just something we measure, it's something our leaders are accountable for delivering. And just in closing, when we look beyond surveys, we also spend time in the field, listening directly to care providers—that feedback has shaped tangible improvements, including expanded partnerships around preventative Community Health and issues like flu clinics and local health fairs. In those cases, care providers told us they wanted to play a stronger role in prevention, and together, we built engagement models that improve outcomes while strengthening care provider satisfaction.

AJMC: How is Elevance helping providers simplify their workflows and reduce administrative complexity?

Reducing administrative burden has long been a problem and an opportunity at Elevance Health, and it's clearly been a priority. Complexity pulls time and energy away from care when it's not managed. When workflows are simpler, care providers can focus on clinical decision-making rather than on paperwork. We concentrate our efforts across 3 key areas as it pertains to care providers: network, clinical, and service. Across all 3, we're leveraging AI digital capabilities and strong industry partnerships to remove friction and improve access to care. A really good example, and priority for us, is around our utilization management (UM) space. For a subset of UM requests, we now use AI to identify and match relevant information from members’ medical records against medical policy or clinical guidelines. When criteria are met, the request is routed immediately to an automation engine for a touchless approval for care providers. That can mean the difference between scheduling a procedure the same day versus waiting days for an administrative response, improving both experience and the outcomes.

Importantly, and I think it’s something that we should note, AI does not automate prior authorization denials. Any denial decision continues to be made by an appropriate clinician through our existing clinical review process. Separately on the care provider data side, we've consolidated digital engagement through Availity, creating a single, consistent channel for care providers to enroll and update their information. This consolidation has increased automated updates, improved director accuracy, and enabled faster claims processing and payment changes that have a direct impact on day-to-day operations for care providers and their teams.

AJMC: How is AI utilized to help solve real healthcare challenges?
We're very deliberate about where and how we apply AI. The goal is not experimentation for its own sake, but solving real problems that care providers and members experience every day. We look at it in 3 key primary ways: reducing manual work, allowing our teams to focus more on care providers, members, and complex problem solving; increasing speed, moving us closer to real-time information sharing and decision making; and lastly, creating more personalized and seamless experiences for our members. The utilization management example that you mentioned and I referred to is one example that touches all 3 areas: accelerating approvals, reducing administrative effort for care providers, and improving the member experience while maintaining appropriate clinical oversight.

AI is also making a meaningful difference in the care provider data accuracy space. Care provider information often arrives in many formats—spreadsheets, templates, or system extracts. As part of a broader provider directory accuracy initiative, we use AI-powered tools to analyze, standardize, and correctly file that information within our systems. This work within the care provider data space has resulted in more than 90% accuracy in information, helping ensure care providers are correctly listed in directories. Members can access care more easily, and administrative processes like payments occur in a timely fashion.

AJMC: How do you ensure technology and AI help clinicians make healthcare simpler rather than add to their workload?
We're very intentional about how we build technology and where we're leveraging that. We build technology to address our business opportunities. Every solution must pass a simple test. Does it make health care easier for care providers and better for members? That means focusing on simplification, personalization, and enabling clinicians to operate at the top of their license. We track outcomes such as reduced call volume, fewer handoffs, and fewer touch points required to administer and deliver care. One area where this approach has had significant impact is on the care provider onboarding and maintenance process, which we're very excited about the work that's happened. These have been longstanding pain points across the industry. Over the past 2 years, we've invested in an end-to-end care provider operating and enrollment platform that delivers a single, standardized, and digital intake across the contract life cycle. Why this is important as it relates to automation AI-enabled workflows is that it's reducing manual effort. It's improving the processes and efficiencies. It's increasing. And transparency for our care providers through real-time status and visibility. It's improving the SLA [service level agreement] reporting, as well, and it's also in application messaging for our care providers and our internal associates. The platform integrates onboarding, contract amendments, ownership changes, network updates, pricing, credentialing, and roster automation, shortening turnaround times and improving experience for both care providers and our internal teams.

AJMC: What issues are addressed with the Health OS platform, and how is it helping payers and providers collaborate today?
Just to provide a little education, Health OS is our interoperability platform designed to address one of the health care's biggest challenges, which is really around fragmented data. Health OS integrates clinical data from multiple sources and connects care providers, payers, and consumers to reduce administrative burden and improve care outcomes. We look at Health OS as an industry-leading approach to solving some of the problems today. Health OS sources data for more than 10,000 care providers and 97 large health systems, covers all 50 states, and supports more than 27 million consumers. It powers more than 47 million automated admission, discharge, and transfer notifications, which is huge. These transmissions and alerts are tangible examples of impact, helping care providers stay informed when patients transition across care settings, supporting better care coordination, and following up and delivering on outcomes by creating more competitive, complete patient records and delivering that information at the point of care. Health OS gives clinicians a more holistic view of the patient without having to search across multiple systems, which is a benefit to both the care provider and our internal associated clinicians. That reduces administrative burden and allows more time for direct member interaction.

AJMC: Looking ahead, what does the “next generation” of payer-provider partnership look like to you? How will platforms like Health OS and programs supporting whole health continue advancing value-based care?

I think the future of health care depends on deeper collaboration. I think we have proven that we have a number of events that are in place to deliver on that. Value -based care is a clear example of that evolution. At Elevance Health, we value value-based care as both a moral imperative and a business one. It improves outcomes, enhances experiences, and helps make the health care system more sustainable. Value-based principles are embedded across our care provider partnerships, product design, and consumer engagement strategies. Platforms like Health OS that you mentioned strengthen care provider information accuracy and enable a connected care ecosystem, helping both care providers and payers see the full picture when care providers and payers share a more complete, real-time view of the patient journey. It strengthens collaboration, supports whole health, and allows value-based care models to scale successfully.