New Efficiencies for PSP

Incredible improvements delivered with practice profiles
We are excited to share results from our initial PSP (Practice Specialty Profiles) trials, where we have observed significant improvements in our ability to generate highly performant medical necessity appeals.
What are Practice Specialty Profiles or PSPs?
Practice Specialty Profiles
 are a way we have fine-tuned provider nuance into our appeals generation process.
For example, consider a general patient advocate and a specialty provider.
General Patient Advocate
May have limited knowledge of the medical condition or procedure, leading to less clarity of purpose and description of the patient's medical condition
May not be able to provide a detailed explanation of the benefits of the treatment, as they may not have specific knowledge of the patient's case
May rely on patient-reported information, which may not be as credible as other forms of evidence
May not have access to the same level of specialized evidence to support the appeal, potentially affecting the persuasiveness of the appeal
May not be as familiar with the cost-effectiveness of the treatment for the specific condition or procedure, which could impact the strength of the appeal
Specialty Provider
Has specific knowledge of the medical condition or procedure, which can lead to greater clarity of purpose and a more detailed description of the patient's medical condition
Can provide a more thorough and detailed explanation of the benefits of the treatment based on their specialty knowledge and experience
Has access to specialized evidence to support the appeal, which can increase the persuasiveness of the appeal
Can use credible evidence to support the treatment based on their specialized knowledge and experience
Has a better understanding of the cost-effectiveness of the treatment for the specific condition or procedure, which can make the appeal more compelling and persuasive.
While these two profiles may seem diametrically opposed, truthfully they are. Over time, general advocacy (while sufficient) will be unable to stand up to the context and nuance originating from a specialty provider. Considering attributes such as tone, clarity, persuasiveness, specificity, confidence, and specialty point of view, the specialty provider offers a stronger insight into the why
 behind a patient's treatment.
Implementing specialty workflows is only an extra step..
PSP vs. No PSP
We analyzed the language differences between appeals with and without PSP training, and identified four attributes - clarity
, persuasiveness
, specificity
, and confidence
. Using on these attributes, we assigned percentages based on RLHF to indicate how well each output performed on each attribute. We observed that the appeal with PSP training performed better overall, as it scored ~50% higher on all attributes compared to appeals without.
We repeated the analysis with the same four attributes. We found that appeals with PSP training performed 56% better based on RLHF averages compared to appeals without.
Average +56% appeal language improvement with PSP
Practice Specialty Profiles (PSP) have shown incredible promise in the early release to Beyond
 plan users.
In reviewing the materials contents and consulting our AutoGPT
 for secondary insight, we identified five attributes that were different between the two outputs - clarity of purpose
, description of the patient's medical condition
, explanation of the benefits of the treatment
, use of credible evidence to support the treatment
, and emphasis on the cost-effectiveness of the treatment
. Through an additional round of RLHF, we observed that the appeal version with PSP performed better on these additional attributes.
We have observed consistent and significant improvements with the implementation of PSP. We have seen improvements in clarity, persuasiveness, specificity, and confidence, and will continue to monitor and make further improvements as necessary.