Premera — Open Questions
Updated as answers come in from calls and correspondence.
We Need From Them
UM Workflow
| # | Question | Status | Answer |
|---|---|---|---|
| 1 | Who is involved in UM? Org structure, teams, key contacts | partial | Chad Murphy (CCO) runs UM ops, Colt runs AI domain, Jamie runs ops alongside Colt. Romilla's team includes the clinicians. ~12 projects in UM domain. |
| 2 | What are the KPIs for UM today? | open | |
| 3 | What criteria sets do they use? | answered | InterQual. Must use evidence-based criteria — legal liability if using AI-generated criteria. |
| 4 | Key vendors in the UM workflow? | partial | InterQual for criteria. "Caroline" for advanced imaging reviews (disruption candidate). |
| 5 | What tech systems support UM today? | partial | ADT/CCD/attachment processing, auto-auth system, summary prediction/prioritization model. They manage within their own environment and tools. |
| 6 | How are cases received? How are they routed? | partial | ADT feeds update ~every 15 min (very chatty HL7). 80-90% of admissions arranged where they have ADT feeds (WA + AK). CCDs much sparser. Claims data supplements with broad history. |
| 7 | Main bottlenecks: initial reviews, P2P, appeals? | partial | Bandwidth for earlier concurrent reviews (review at day 5, not earlier). Capacity to apply AI talent to all initiatives. Year-1 items pushed to year-2. |
| 8 | Internal lingo we should know? | partial | "Auto-auth" = automated authorization. Three milestones: initial prior auth, concurrent review, daily review. |
| 9 | What does the UM workflow look like end-to-end? | partial | Initial prior auth → concurrent at day 5 → daily for some contracts. Non-inpatient fully automated. Inpatient more complex, requires all interfaces. |
| 10 | What's failed or been painful in past tech deployments? | open |
Tech Stack
| # | Question | Status | Answer |
|---|---|---|---|
| 11 | Internal dev standards? | open | |
| 12 | Platform vendors? | partial | InterQual for criteria. Have their own AI/ML infrastructure built over 2 years. |
| 13 | Who approves technical decisions? | partial | Colt for UM AI domain. Mark for vendor management/contracting. |
| 14 | Do they want products built within Premera's environment? | answered | Yes. Colt: "Oftentimes when we work in this cutting edge way on live data, it's better to allow you access to our environments." They manage within their own tools. |
| 15 | Languages/coding frameworks? | open | |
| 16 | Existing relationships with Anthropic/OpenAI/MSFT/AWS? | open | |
| 17 | Existing AI infrastructure? | partial | 2+ years building. Production auto-auth. Summary prediction model. ADT processing. Significant. |
| 18 | Existing EMR integrations? | partial | ADT feeds from hospitals in WA/AK. 80-90% of admissions covered. CCDs sparser. |
| 19 | ADT feeds — API integration layer or point-to-point? | open | They receive ADT/CCD/attachments but architecture unclear. |
| 20 | Expected data requirements and access constraints? | partial | ADT feeds are priority over CCDs. Claims data for broad history. Need to understand what access we'd get. |
Project Management
| # | Question | Status | Answer |
|---|---|---|---|
| 21 | Who should be our day-to-day POC? | partial | Likely Colt or Jamie. TBD after Chad/Jamie call. |
| 22 | Who do we communicate updates to? | open | |
| 23 | Should we be setting milestones? | open | |
| 24 | Technical ownership preferences? | partial | Colt runs UM AI domain. Chad is business leader. Jamie runs ops. |
Commercial / Legal
| # | Question | Status | Answer |
|---|---|---|---|
| 25 | What level of contract formality to start moving? | partial | Goes through Mark (vendor management). Colt asked about exploring contracting. Talhah (CFO) involved for funding. |
| 26 | What diligence do they need to do on us? | open | |
| 27 | What assurances do they need from us? | open | |
| 28 | What can we expect from them (commitments)? | open | |
| 29 | Regulatory/compliance gates to clear? | partial | Can automate approvals, NOT denials. Must use evidence-based criteria (InterQual). |
Strategic
| # | Question | Status | Answer |
|---|---|---|---|
| 30 | Broader UM transformation alignment? | answered | Yes. Dave: "a lot of vendors are going to be disrupted and it's a good thing for American healthcare." Strong alignment on insourcing and internal capability building. |
| 31 | Where do we start among the ~12 UM AI initiatives? | partial | Colt suggested year-2 items: imaging (ortho), lab auto-auth, insourcing to remove vendor expense. Need to discuss with Chad/Jamie. |
| 32 | What's their expected timeline? | partial | 2-year AI roadmap. Want to accelerate year-2 to year-1. |
| 33 | What does success look like to them? | partial | Expand capacity, accelerate roadmap, reduce vendor expense, insource capabilities. |
They Need From Us
| # | Question | Status | Answer |
|---|---|---|---|
| 1 | Security deck and standard controls | open | Thomas mentioned HIPAA, Vercel, Neon, MFA on Jan 5 call. Formal deck not sent. |
| 2 | Can we work within their environment? | open | Colt suggested this. We need to confirm capability. |
| 3 | Volume/scale we can handle? | open | Colt asked about data volume. |
| 4 | Hallucination controls / accuracy? | open | Colt asked. We mentioned prompt controls but no formal answer. |
| 5 | Prior auth capability (not just concurrent review)? | open | Romilla's #1 ask. Thomas said we haven't built that agent yet. |