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'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

• Up to 60% workload reduction across utilization management teams

• 90%+ consistency in decision-making, improving fairness and reducing provider abrasion

• ~$1.2 million projected annual cost savings across multiple IPAs

• Full compliance and transparency in AI-assisted medical decision-making

"These results are just the beginning," said Ricky Sahu, CEO and Co-Founder of GenHealth.ai. "As we expand our UM automation capabilities into behavioral health, concurrent review, and SUD services, the impact on efficiency and patient access to care will multiply."

Download the full case study to learn more about the implementation details and outcomes here.

About GenHealth.ai

GenHealth.ai builds AI-native infrastructure for healthcare organizations, empowering payers and providers to automate utilization management, prior authorization, and clinical review processes. By combining large medical models, predictive analytics, and human-centered design, GenHealth enables clients to streamline operations, ensure compliance, and improve patient outcomes.

For more information, visit www.genhealth.ai.

About Guidehealth

Guidehealth is an At Risk Managed Services Organization (MSO) that partners with Independent Physician Associations (IPAs) and provider networks to improve care quality and operational efficiency. The company specializes in value-based care programs, utilization management, and provider engagement strategies. Guidehealth leverages technology and data-driven insights to optimize patient outcomes while supporting clinicians in delivering coordinated, high-quality care

SOURCE: Genhealth AI