Mission Empowers Paynela's AI-Driven Patient Financial Assistance

Paynela, a Puerto Rico-based healthcare financing innovator, partnered with Mission to revolutionize patient financial assistance through cutting-edge solutions powered by AWS. Through Mission's expertise in AWS technologies and AI integration, Paynela harnessed the power of generative AI to analyze complex healthcare data, resulting in deeper insights and expanded patient support capabilities. This solution makes healthcare more accessible and helps patients manage out-of-pocket medical expenses with dignity and ease.

Paynela is a healthcare financing company that aims to help patients pay for their out-of-pocket costs for high-cost specialty products. Based in Puerto Rico, Paynela focuses on using technology, AI, and innovation to create or enhance patient assistance programs offered by drug manufacturers. Their innovative solutions support patients' ability to qualify for, obtain, and utilize funds to access the care they need.

The medical adjudication process is traditionally manual due to the complex nature of healthcare claims. The manual nature of these procedures often cause significant backlogs, delaying payments to patients in a timely manner. Paynela recognized the need to innovate its processes and automate payment adjudications to streamline operations and improve patient experience.

Paynela chose Mission as its AWS partner due to Mission’s proven expertise in Generative AI and collaborative approach. Mission offered a true partnership model, working closely with Paynela to address their specific challenges. As Mary-Beth Macaluso, Chief Executive Officer of Paynela, emphasized, "The solution that we were able to build with Mission and AWS has allowed Paynela to focus on strategy more than manual processes."

AWS's robust suite of services, particularly in AI and machine learning, provided the ideal foundation for Paynela's innovative solution. Amazon Bedrock was chosen for its ability to support a variety of high-performing foundation models, enabling Paynela to select the most suitable model for its needs. Additionally, other AWS services contributed to an efficient pipeline, while the platform’s strong security and compliance framework protected sensitive healthcare data. This allowed Paynela to innovate confidently within industry regulations.

Mission collaborated with Paynela to understand their challenges and design a tailored solution to address their needs. By integrating Optical Character Recognition (OCR) technology with Amazon Textract, the team was able to automate the extraction of data from various medical documents, which previously required extensive manual input. This automation not only accelerated the processing time but also minimized human error, ensuring greater accuracy in data handling.

In addition to OCR, implementing a Large Language Model (LLM) further enhanced Paynela's capabilities by enabling sophisticated analysis of the extracted data. This combination allowed for contextual understanding and interpretation of complex healthcare information. Amazon Bedrock provided access to advanced foundation models that could be fine-tuned for specific tasks, empowering Paynela to leverage generative AI for deeper insights into patient financial assistance trends and needs. 

This approach created a seamless workflow that transformed Paynela’s operations, allowing them to focus on strategic initiatives rather than being bogged down by manual processes. As a result, Paynela is now better equipped to support patients and healthcare providers alike, fostering an environment where financial assistance is not just accessible but also efficient and effective.

The partnership with Mission has enabled Paynela to shift its focus from manual processes to strategic initiatives. By leveraging AI-powered automation, Paynela has improved the efficiency and accuracy of its adjudication process. Previously, reviewing a claim could take up to two business days, but this process now takes three minutes or less with the new system. The time required to adjudicate and approve a claim has also been reduced from six to eight minutes to just one minute or less. In addition to these efficiency gains, accuracy has improved from 90% to 99%.

This automation reduces backlogs and ensures that patients receive financial assistance faster. With minimal manual intervention required, Paynela has eliminated constraints due to business hours, allowing for 24/7 processing. With generative AI, Paynela can now delve deeper into data, gaining valuable insights that inform strategic roadmaps with clients and ultimately help more patients. With Mission's support, Paynela is positioned to innovate further and enhance patient assistance programs, ensuring patients receive the care they need quickly and efficiently.