JPM25, Day 1: CHAI launches working group on use of AI for prior auth; IU Health's focus on team culture

SAN FRANCISCO—The annual J.P. Morgan Healthcare Conference is officially underway, bringing the healthcare and biopharma industries' biggest wheelers and dealers to San Francisco. For a look at some of the biggest trends to watch this week, check out our preview here.

We have you covered with the biggest updates from Monday's sessions in this roundup, as well as across our website. Keep up with news from biopharma thanks to the Fierce Biotech team in their daily tracker, too.

Follow along with all of our JPM 2025 coverage here


Monday, 7 p.m. PT, Jan. 13

CHAI launches working group for prior auth AI

The Coalition for Health AI (CHAI), a nonprofit focused on creating guardrails for responsible AI, launched a working group focused on exploring the use of AI for prior authorization.

The working group will consist of executives at health plans and health systems “coming together” to reach consensus on best practices, Brian Anderson, CEO and co-founder of CHAI, told Fierce Healthcare during an interview on the sidelines of the J.P. Morgan Healthcare Conference in San Francisco.

CHAI is a private-sector coalition committed to developing industry best practices and frameworks to address the urgent need for independent validation for quality assurance, representation, and ethical practices for health AI.

Patient advocates will also participate in the working group, Anderson said.

“This is an area where there's been a lot of tension and concern about the opaqueness about how prior auth works, so shedding some light and transparency on how payers and health systems agree on going about the prior auth process using AI, or where not to use AI, I think is an exciting moment,” Anderson said.

“It's not going to be easy. It's probably going to take us six months or so to get the first draft out, but I think doing it in a transparent way and ensuring that the stakeholders have a path to adopting it and actually using it is going to be really important,” he said. “I look to a future where we have an agreed-upon framework that all parties agree on for best practices and one way forward, and hopefully that will address a lot of the concerns that I know many patient advocates have had.”

CHAI also champions the creation of a national network of independent assurance labs for healthcare AI.

Last summer, CHAI released a draft Responsible AI Framework that includes an Assurance Standards Guide and a set of checklists to be used both in the eventual assessment of AI in CHAI assurance labs and to be available open access for companies to internally evaluate the quality of their AI products.

The Assurance Standards Guide details six use cases of the application of AI in healthcare with prior authorization cited as one of those use cases.

Monday, 6 p.m. PT, Jan. 13

How IU Health is putting a focus on team culture

As Indiana University Health charts a path toward growth and quality improvement, it's putting a focus on the satisfaction of its employees as a key driver.

Dennis Murphy, CEO of IU Health, said during a session at JPM on Monday afternoon that in a tight labor market it's critical for an organization to differentiate itself. And the health system is doing that by offering a living wage, competitive benefits and financial supports such as childcare.

In addition, the health system is looking at ways to adjust its organizational operations to make jobs work better. For one, it's taken steps to reduce "management layers," Murphy said, with increases in "spans of control" for employees ready to take on that level of responsibility.

Conversely, IU Health is also reducing the management burden for individuals who may have large teams to oversee. He gave the example of someone overseeing a team of more than 100 in intensive care.

The goal, he said, is to create jobs that "actually people can succeed at." 

"Job architecture has been really important, because in most organizations, the only way you can succeed is to become management," Murphy said. "And what we said is, if you're a really talented caregiver or really talented in it, we want you to stay in those roles."

In addition, the health system is tying key preventive care measures and other health metrics into the performance of its teams, putting them in the driver's seat for improving outcomes.

Murphy said that investments in the workforce and improvements can play a role in driving better health for its patients.

Monday, 2 p.m. PT, Jan. 13

Intermountain Health shares growth plans in Las Vegas with new children's hospital

In October, Intermountain Health revealed plans to build a children's hospital in Las Vegas, the first stand-alone pediatric hospital

The hospital will be built at UNLV’s Harry Reid Research and Technology Park.

Las Vegas is the largest metro area in the U.S. without its own dedicated stand-alone pediatric hospital, Clay Ashdown, Intermountain's chief financial officer, said during the health system's presentation Monday afternoon.

"We are coming in to address that need. It's frankly long overdue," Ashdown said. "A study was done that indicated that Intermountain was an ideal partner to develop that, to extrapolate the expertise that we have demonstrated with our other pediatric campuses and bring it into that market that desperately needs it. We are excited about the prospect; it will be a journey, but again, the community is incredibly excited about what this asset will bring."

He added, "Up until this point, unfortunately, way too many of those kids were being forced to travel to surrounding states, and this will allow people to receive that critical care close to home."

The health system said the new free-standing children's hospital will provide comprehensive pediatric hospital services and is expected to see 10,000 admissions, 15,000 clinic visits, 10,000 surgeries and 24,000 emergency visits.

There are approximately 500,000 children in the Las Vegas area.

Intermountain Health offers patient care at more than 65 clinics across Southern Nevada. With its extended provider network, Intermountain Health delivers patient-centered primary, specialty, and urgent care services to approximately 350,000 Southern Nevadans in Clark and Nye counties. 

Building a new pediatric hospital in Southern Nevada could signal further market expansion in that area for the health system.

"We've been in Las Vegas since 2019 and we purchased Health Partners, and have the second largest medical group there. We have about 90,000 MA [Medicare Advantage] lives," said Rob Allen, president and CEO at Intermountain Health. "Pediatrics is a new angle for us. [Las Vegas] is a place now that we would consider a part of the important work that we do in the interior West. One of the huge gaps in that community is children's health. And sadly, tens of thousands of kids leave Las Vegas or leave Nevada every year to go to California and to Utah for children's care. This is a way to bring that care where they are and help people stay home."

Allen added, "We just think it's the right move strategically, as well as mission-wise, to better serve the people in the way that they need to be served. And it's just expanding on a foothold we already have."

The final cost of the new hospital is yet to be determined, but one report pegged the cost at $1 billion.

Monday, 10:30 a.m. PT, Jan. 13

ConcertAI touts growth, unveils AI product releases

Trial software provider ConcertAI, which presented today, shared key financial results, partnerships and new AI products at the conference.

In 2024, 72% of total revenues were annually recurring (ARR) and the company exited FY2024 profitable, with mid-teens unadjusted EBITDA margins, executives said.

ConcertAI, founded in 2018, is a multi-modal research-grade Data-as-a-Service (DaaS) and AI Software-as-a-Service (SaaS) company in oncology, providing solutions to 50 life science companies and 2,000 healthcare providers and research sites.

In December 2023, it acquired the American Society of Clinical Oncology’s CancerLinQ entity, one of the largest intelligent oncology research and quality networks in the world. That formed the foundation of ConcertAI’s CARAai clinical RWD cloud with 5.5 million multi-modal oncology real-world data records.

ConcertAI is now planning to launch new DaaS and AI SaaS solutions built from the CARAai platform this year. A new DaaS product, Precision360, is a population-scale Gen AI and Agentic AI curated data solution that offers a detailed view of the patient journey with exceptional recency and low latency. Another product, Precision Insights Suite, supports major lifesScience functions, and the company’s Accelerated Clinical Trial and Accelerated Patient Actions Suites are enterprise-grade solutions that support end-to-end workflows for clinical development and therapeutic-specific commercial functions respectively.

The company nows serve 75% of the top Life Science companies, more than 50% of the largest global healthcare providers, according to Jeff Elton, PhD., CEO of ConcertAI. "Our products are evolving from highly specialized solutions for experts to enterprise-level AI SaaS and DaaS solutions,” he said.

Monday, 9 a.m. PT Jan. 13

Waystar unveils generative tool to automate denied claims appeals

Healthcare payment software company Waystar rolled out Waystar AltitudeAI, a comprehensive set of AI capabilities for providers, including a new generative AI innovation focused on appealing denied claims.

By autonomously generating appeal letters, Waystar aims to help providers recover a substantial portion of payments tied to more than 450 million annually denied claims, ultimately enabling faster and more accurate healthcare payments. The company made its announcement Monday morning during the J.P. Morgan Healthcare Conference in San Francisco.

"More than half of denied claims ultimately get overturned, but the appeal process is time-consuming, complex, and error-prone for providers," Matt Hawkins, Chief Executive Officer of Waystar, said in a statement. "Generative AI unlocks a new era of productivity and precision, transforming how the industry simplifies claims, appeals and payment workflows. With Waystar's AI-powered software platform, providers of all sizes are better equipped to appeal denied claims with unprecedented efficiency, accuracy and ease.”

Waystar went public in June, raising $967.5 million, and marking the biggest health tech IPO since 2022. The company offers healthcare payment and revenue cycle management tools, serving more than 30,000 customers representing approximately 1 million distinct providers.

Waystar processes over 5 billion healthcare payment transactions, including over $1.2 trillion in annual gross claims and spanning approximately 50% of U.S. patients. Its revenue has grown nearly 20% year over year across the first nine months of 2024, while the number of clients generating more than $100,000 in revenue has grown 14% to 1,173 as of the end of Q3.

The company was formed in 2017 by the merger of revenue cycle management companies Navicure and ZirMed. Renamed Waystar in February 2018, the company provides healthcare organizations with "mission-critical cloud software that simplifies healthcare payments." Its technology helps to manage claims submissions, payer remittances and prior authorizations.

The new GenAI tool builds on Waystar's partnership with Google Cloud to use generative AI technology for revenue cycle capabilities. It is the first of 12 provider-focused generative AI use cases the pair have identified.

“Decision makers are grappling with multiple point solutions. They're constantly trying to manage and integrate multiple point solutions of theirs, and even within the revenue cycle, sometimes they're using more than 5, 6, 8 different solutions that are point solutions in nature, and trying to figure out how to make them work,” Hawkins said during a Monday presentation.

“…They're looking for a trusted partner that perhaps isn't a point solution, it's a platform approach where they can, they can interact with them. And we think that Waystar could be that type of trusted partner.”

Speaking to potential investors on Monday, Hawkins highlighted room for growth within the company’s existing install base of providers and well as opportunities to capture new clients. Of note, Waystar onboarded more than 30,000 new providers and drew plenty of new interest in the months following competitor Change Healthcare’s cybersecurity incident.

Hawkins also pointed to mounting criticism and public awareness of insurers’ claims denial practices as an opportunity for his company to make a splash.

“there’s a big discussion in our society about claims getting denied at an alarming rate, and I think we just have this unique opportunity as builders of software—as we leverage artificial intelligence and Gen AI—to do good in society,” he said during the conference. “We can dramatically reduce the likelihood that a claim gets denied and allow providers to rapidly follow up. … That’s what gets me excited.”