Staff , 2025-08-21 22:39:00
Clinical documentation is possibly the biggest bane of existence for countless clinicians and the claims management staff that have to rely on them to get reimbursement. Health systems have spent countless hours and money on clinical documentation improvement.
And now automation and AI can be a game changer for these harried sould within health systems juggling dual priorities of containing cost and delivering great care, believes Jeremy Delinsky. CEO of Smarter Technologies. Providers have been battling small margins for a long time and now payers are watching their expenses given that they are seeing greater healthcare utilization. So, having a clean claims process and data without the need for additional staff is doubly important.
Smarter Technologies aims to help hospitals and health systems do just that. The company has been created with the amalgamation of three companies – SmarterDx that provides pre-billed clinical documentation improvement tools focusing on the accuracy of a clincial note; Thoughtful.ai, which is an agentic AI platform that automates many parts of revenue cycle management and finally Access Healthcare, where healthcare experts in RCM help train the agents that Thoughtful.ai has developed.
As a whole, Smarter Technologies has more than 200 hospital, health system and industry partner customers. It manages over $200 billion revenue annually and processes more than 400 million transactions annually. It’s AI automation technology support over 500,00O providers
In this episode Delinsky touched on:
- How Smarter Technologies can help healthcare organizations boost their efforts in RCM by not by imposing tech but meeting them where they are
- The competitive landscape where ambient AI companies automating clinical documentation and the clinical note are now wading into revenue cycle management and prior authorization
- What Epic’s entry into AI charting may mean
Here’s the video and below that is the audio of this episode of MedCity Pivot:
Here’s the podcast
Here is an AI-generated transcript of the conversation:
Arundhati:
Hello and welcome to me City News’s Pivot Podcast. I am Arundhati Parmar, your host. Health systems are under tremendous pressure to deliver quality care while increasing efficiency and improving their bottom lines. One company that believes it can help cash strapped health systems, cut their costs and improve their operational efficiency by leveraging technology is smarter technologies.
So today I’m speaking with Jeremy Delinsky, CEO of Smarter Technologies about the company’s efforts in clinical documentation improvement and revenue cycle management. This episode is sponsored by Smarter Technologies.
Arundhati : Hello and welcome, Jeremy to the Met City Pivot Podcast.
Jeremy: Thanks for having me. Appreciate it. It’s nice to see you again.
Arundhati: Nice to see you too. You know, Jeremy, it’s really nice to have you [00:01:00] on this specific episode because we’re talking about transforming, you know, hospital operations and you know, you run a company that is all about making hospitals operate more efficiently and dare I say, more profitably. So let’s sort of begin there.
Smarter Technologies came into being when three companies access healthcare, thoughtful ai, and smarter Dx was acquired and put together by private equity firm, new modern Capital. And then you came on as CEO. Each of these companies has its own unique offerings, so can you briefly elaborate on each of those?
Jeremy: sure. So, the reason we. Brought these three companies together is that we’re really focused on doing two primary things. Number one is getting the invoice right for what happens in, in admission or a patient encounter. And to get that right is fundamentally an act of medical documentation [00:02:00] where you need to have it right the first time.
If you’re gonna get paid appropriately, downstream. And then the second thing is then if you get it right, how do you then collect? At the lowest cost, at the highest quality with the least friction. And so, these three platform companies give us those capabilities. So Smarter dx um, is pre-bill, CDI.
Company that focuses on that accuracy of medical documentation. Thoughtful AI is an agentic AI platform that automates several use cases in the revenue cycle and, you know, automates maybe up to 70% of the work. And then the super talented, experienced expert workforce. At Access Healthcare ha helps train the virtual agents that Thoughtful has developed.
But also, you know, healthcare is really complicated and for a [00:03:00] variety of reasons related to compliance. Or just, you know, we’re not there yet on the ability to automate certain tasks. You need to still have people in the loop, right to. To assess the overall performance of the system and to fulfill the work when this, when the technology itself can’t.
And that was the theory of why these three companies came together?
Arundhati: So I wanted to ask a follow up. You talked about having humans in the loop. I understand that especially as we ramp up our use of artificial intelligence, you wanna make sure that, you know, the i’s are being dotted and the t’s are being crossed and all of that. But if we still have people in the mix, then where is the cost efficiencies coming from?
Jeremy: Well, if you have a lot fewer, if you can automate 70% of the work then that’s a massive savings. Right? And sometimes what people are doing, you know, they’ve already offshored a lot and they’re asking the question like, well now what do I do in the revenue cycle? You know, I’ve been offshoring for years.
But I have a [00:04:00] cost takeout mandate in our cm, what do I do? And so, or, and then some organizations haven’t even done that, right? Where they’re still, you know, you know, work that they’ve kept onshore because they felt like that’s important to do either from a brand perspective or from. You know, they’re maybe a large employer and I think that the way that we can help is, you know, we don’t wanna take over the end-to-end revenue cycle.
We want to meet our customers and health systems where they are, where they might need help with, you know, AR management, but they don’t need help with prior auth. Right. And so what we think it’s our job to do is to be extenders of our clients. And then when we do the work for them, it is a lot less expensive than their alternatives on the market.
And because so much of it is automated it’s very it’s very high quality, right? Because virtual agents don’t make the same kind of mistakes that people do,
Arundhati: Sure.
Jeremy: and the turnaround time is really fast, right? You don’t have [00:05:00] to deal with. Sort of staffing and shift work. You know, work can just magically get done or near magically get done as it flows into a queue or it just gets burned down kind of the next day because you spin up to as much capacity as you need, whereas like getting the staffing right has been a very specific focus.
Within RCM for a very long time, and the ability to move away from that is a huge unlock in terms of how you can also start getting some costs outta the system.
rundhati: So you mentioned clinical documentation, CDI clinical document documentation improvement. And that has been a challenging area for hospitals and health systems and they are now prioritizing this. Can you explain sort of why they’re prioritizing, its so much? Is it purely from a reimbursement perspective?
And what role smarter technologies plays.
Jeremy: Yeah, I mean, I think that first of all, everybody wants medical records to be accurate. And that’s really important for [00:06:00] safety among other things. But there is a very challenging reimbursement environment right now, you know, so, you know, in the last two decades, every American’s health information became digital and how we pay for healthcare.
Hasn’t fundamentally changed, and I’m not talking about, you know, fee for service or value based care. Yes, there have been lots of successful example examples of VBC, but I’m talking about the underlying chassis, the transactions that make it all work. And so what payers. Have been focused on and look rightly so, like if you read, you know, the CMS Medicare Managed Care manual, like we should only be paying for care that’s medical, medically necessity medically necessary as a society, right?
And, but what payers have been doing is using this influx and of availability of clinical data in a way where they want to get for certain kinds of care. Those [00:07:00] records before they will make payment. And that is something like a, like of all sort of denials. You know, and this isn’t considered a final denial usually, but, you know, a huge volume of medical records requests so they can, so that they can even adjudicate the claim.
And then, you know, medical necessity. Has become a significant focus on of the payment integrity industry, right? So the payment payment integrity industry started as like, Hey, are you billing the right insurance company? Essentially like COB subrogation. And then it started to get into sort of like, you know, claim validation itself and auditing, they have, you know, they, they’re a few years ahead leveraging medical data, right? So they’re, they are requesting charts to, after payment has already been made, reevaluate whether those payments were in fact, for medically necessary care. So, if you are a health system right now, you are dealing with this every single day, just a ton of requests for [00:08:00] documentation.
And sort of, you know, once it’s, once you know, the chart. You know, six months after the fact, you can’t open the chart again. Right? Like it’s, you know, like you’re, if you don’t capture at the time of the service what really happened there, you know, you’ve really missed an opportunity. And so that is why we’ve chosen to focus there because it’s such a pain point with, you know, very few guardrails on that business process in any
Jeremy: And then the whole idea of what is medically ne necessary is it, you know, it’s so subjective, right? From it, it might differ from, you know, provider to provider and even peer to peer. I think it’s tough. I’m curious to hear your opinion on it. You know, I had pain in my right foot for the longest time and I didn’t know what it was. So they first, I thought maybe I twisted an ankle or something. At first they did an x-ray, then they did an ultrasound, and then finally they did an MRI to figure, you know, out what it was.
Now I’m guessing they went for the X-ray, because that’s the [00:09:00] cheapest modality to see what’s happening, right? But then they did all these additional things to. Ultimately go for the most expensive way to figure out what was truly wrong. So I don’t know who was right there was the provider right in going through these additional steps because did they didn’t want push back from the payer?
Or was it the person wasn’t experienced enough to realize that, okay, maybe MRI is the way to go. It’s, I don’t know. I have questions about that.
Jeremy: Yeah, no, like look, I think that, you know, when it comes to imaging, people do wanna start with the lowest cost and to see whether additional more expensive imaging is necessary. And I think that, you know, that’s been behavior that’s been very much trained through the prior authorization process over many years.
Right. And you know, I think that there is a sense you’ve gotta sort of exhaust. The less expensive options before you step into a more expensive option. And in many ways that’s like a good thing, right? In, in terms of spending our healthcare dollars. Well, but I think you’re getting at, you [00:10:00] know, this idea of medical necessity.
I would say that, you know, a lot of the time, if the documentation is clear,
There’s no controversy.
Arundhati: Makes
Jeremy: There is controversy even when the documentation is clear in a subset of medical necessity reviews, where there might be some gray area in clinical guidelines, right? Where you know both the payer and the provider are using, you know, whether it’s Milliman or InterQual.
And that becomes sort of the focus of the battle, right? Where you get. The clinical advisors the physician advisors on the phone for a peer-to-peer with the health plan. And, you know, my experience kind of witnessing that process evolve over the years is that most of the time the peer-to-peer results in.
The right thing being done for the patient, but it oftentimes requires, [00:11:00] you know, a physician who has to do a lot of preparation for that call, assisted by lots of people behind the scenes to be able to make that case to the insurance company. And so if you can, you know, document as best as possible, the objective truth about what happened, hopefully we create a system where over time you have fewer and fewer of those very expensive, frustrating interactions.
Right? And it’s expensive from the payer’s perspective as well, right? But we’ve gotta have a better way of. Adjudicating medical necessity. And that, you know, ultimately to me sounds like something where industry is gonna have to come together and create some solutions, right? Because, you know, we’ve been waiting, you know, we’re not gonna have overnight sort of the federal government come to us with a brand new way of running all of the [00:12:00] administration of healthcare.
It’s just not
Arundhati: Absolutely.
Jeremy: And when you look at. The societal frustration with the patient experience. It’s about this stuff, right? It’s about the fact that there’s a lot of things that go wrong in the process that create a lot of heartache and confusion along the way. And if we imagine eliminating half of those,
Arundhati: Right.
Jeremy: right?
And then the next year you try to go eliminate another half of them, right? Like that. I don’t think that industry has come together and said that actually is our mission together to figure out how to make these processes work better for everyone else. And I don’t know whether it’s because it feels like a zero sum game between the payer and the provider, but at the end of the day, I think everyone, you know, agrees that we wanna pay for four services that were, you know, rendered in good faith, that were medically necessary.
And the faster we get to that answer, I think the better.
Arundhati: Absolutely. So I wanted to ask you about this part about [00:13:00] getting to it faster, right? When we met back in May, you talked about how, you know, payers have for the longest time invested in AI technologies and. Providers are now sort of beginning to catch up and I don’t know catch up is the right term or not, but they’re getting on board with adopting automation and adopting artificial intelligence.
But what I’m seeing is that they’re focusing a lot on ambient ai on clinical documentation. But that’s only a piece. I mean, you can’t really say, okay, I saved that this many hours in not doing notes because an ambient AI created that note for me. And so I saw this many more patients. You can’t really dot, you know, there’s no clear ROI in that respect.
‘Cause that’s now how it works. From what I understand, it’s not like there’s so much time is freed up that you’re seeing more patients. So the ambient AI pays for itself. That is not the case. So now I’m seeing that AI companies are branching out, like MB AI companies are branching out. What do you think of this market trend?
I [00:14:00] mean, you saw this latest news, you know, abridge, which was in clinical documentation is now gonna do prior authorization with Highmark Health. So I just wanted your opinion on sort of this market trend and where you see true ROI come for providers in their battle to, to bone up on artificial intelligence, I guess.
Jeremy: Yeah, I think that great question. So, you know, first of all, what I would say is that I think that the ambient providers are creating a lot of value for their customers, right? And, you know, when and I think that value, you know, I don’t know how you. You know, pencil out in a spreadsheet necessarily the benefit of a more refreshed physician who doesn’t spend as much time in the evening in pajamas doing documentation.
Right. Like hard to put a dollar sort of e Exactly. And so I really admire that the work that they’re doing. And I think, you know, backing up a little bit in every other industry. There’s room to pay for [00:15:00] some delight to make the work, you know, the people who are doing the work. Have their job simply be better.
And I think, you know, that we’re talking about ROI, so much in this industry, I think is a reflection of the financial pressures that health systems have, right? They’ve made these huge investments in you know, IT infrastructure and EHRs and you know, in it, and they’re like, wow, now I need to. Pay for something more.
And so I think it really just reflects, I think it’s unusual that, you know, you know, people don’t ask, you know, what Slack, you know, what we get from, you know, ROI on Slack in a lot of technology companies, for instance. But, you know, I do think that we are focused at Smarter is on measurable calculable.
On investment that is tied specifically to revenue and cost. And I think that, a world where there’s so [00:16:00] much noise, right? So we are, and I can’t remember a more exciting time in my career regarding sort of the pace of innovation and just the sheer you know, volume of companies that appear to be doing very interesting things, you know, to cut through the noise. You know, if you’re a, if you’re, think about it, if you’re a health system executive, you’re probably getting phone calls every day of the week for, you know, people trying to get a meeting with you. You know, what do you, how do you evaluate that? And I think that, and then, and I think it’s really, it. Having ROI is important because you know, oftentimes executives go out on a limb when they say, look, I really wanna bring in this solution and I’m, you know, putting some of my reputation on the line that it’s gonna be worth it.
Right? And so, and so, you know, that is why, you know, I think it’s easier to sell something you know, where it’s very easy to understand the value that is being generated from it.
You know, it is sort of sad to me, right [00:17:00] that that. We can’t necessarily, like, I wish there was a little more like, sort of dollars in the system to also focus on the things that are a little bit, you know, maybe squishier on the ROI front, but could make our health, our healthcare system better.
And that’s, you know, not work that we do, that’s work that a lot of other companies do. But but it’s not surprising to me that the ambient vendors would take a look at the work that’s adjacent to what they’re doing and say. Hey, like, it looks like we might be able to have a neat solution to that.
You know, it’s really hard work, right? Like if, you know, you know, revenue cycle is about paying attention to an unbelievable amount of tiny details, huge variation. And, you know, it’s a, to be a provider in this space you have to have a very strong focus on service. Because, you know. This isn’t, I don’t think that, you know, a huge amount of success is gonna be had from selling tools. I think selling [00:18:00] outcomes is is, you know, going to be the best way to cut through a lot of noise in the market. I.
Arundhati: So you are not bothered by any extra competition that comes from these companies kind of treading into what you guys do on an everyday basis.
Jeremy: Look I can’t predict, like this is wild, right? Like, who knows what things are gonna look like five years from now? I think the instinct in healthcare to be afraid of competition is not good.
Arundhati: Okay.
Jeremy: And I did a little bit of sabbatical outside of healthcare for a couple years when I’ve worked as the CTO of Wayfair.
And I went from Athena to Wayfair and then to devoted and then now to smarter. And there’s something unusual when you go into that kind of environment where literally every single day you’re working to understand if the consumer’s gonna show up.
Arundhati: Right.
Jeremy: And a lot of things become simple in that world, which is the most customer centric businesses win.
Arundhati: True.
Jeremy: And I [00:19:00] personally think that, you know, I don’t, I think in healthcare there have been, you know, various cases over time where once you get a certain degree of scale. You know, and you see this in enterprise SaaS too, right? Like, you make people buy more than they might want or need. And that, you know, once you achieve a certain amount of scale, it’s harder for other innovative solutions to start.
Sort of, you know, making their way through the commercial journey. And so I don’t want to, you know, I, i’m a citizen too. Right. And and I think we’ve built a phenomenal team. So, I think competition’s good for everybody.
arundhati_1_08-20-2025_130558: So bring it on essentially.
Jeremy: Yeah. Yeah. I.
Arundhati: Awesome. You talked about the health system executive who is getting all these calls to say, you buy my technology, buy my tower, implement my technology within your health system. I have seen some hospitals completely outsource it to Epic. So if you’re not on the Epic ecosystem, you’re never gonna have these people as your [00:20:00] customers.
Right. So I’m curious about the fact that Epic just announced, that they are getting into AI charting and they’re working with Microsoft. They’re going to do you know, chart navigation and all of that. So this is an example now of a traditionally HR company getting into artificial intelligence and doing a straight up collaboration.
Now, you also you meaning Smarter Technologies also has a relationship with Epic. How does this sort of collaboration impact you guys?
Jeremy: Look, I’m not surprised that. That anyone isn’t thinking about how they improve their products through the use of ai. I think that, you know, from our point of view we do an immense amount of work on behalf of our clients too, right? Where it isn’t. Just an act of like writing some software, shipping it and making it available to customers.
And I’m not saying that’s that’s not what what Epic is necessarily doing either, but there is so much like, you know, clinician human in the loop work at the beginning of [00:21:00] building a new model. There’s a huge amount of labor that goes into truly. Understanding the revenue cycle and delivering the outcome, and you need that labor to then train the automation, right?
And so I think that there are certain kinds of AI that lend themselves to be, I might call them lighter solutions within an existing software platform. And so it doesn’t surprise me at all, right? That’s, you know, if you look at all of enterprise SaaS, like that’s what they’re doing. But you know, we’re not selling AI or a feature, right?
Like of a, of an electronic health record or we’re providing a business service that’s around sort of a very quantitative business result. And. You know, and I and so I, you know, I don’t, I’m not surprised at all about, you know, and I wasn’t in the meeting, so I, you know, I’m just following along with everybody else.
But I didn’t, it wasn’t a moment [00:22:00] of panic for me. You know, because it seemed like a very rational thing to do. And it is convenient for you know, customers to have an easy way of integrating. Right. And, you know, I think as long as the platform stays open and I believe it will through, you know, all the public APIs you know, I think that you’ve seen a lot of penetration within the epic base of really great cutting edge new solutions.
And I don’t expect that to stop.
Arundhati: Excellent. And then final question. All these companies are coming into revenue cycle and doing some of the things that you are doing. What are you interested in? What adjacencies are you interested in? What kind of transactions may we see in the future from smarter technologies?
Jeremy: Ah, tricky question. I see what you did there. You know, we, so I’ll say a couple things. One is that we have an incredibly capable engineering team within our company, and that was so much of what got me excited about taking on this role, which is that we’re rapid product builders ourselves.
That said. [00:23:00] Sometimes you will see on the market, new capabilities or a fantastic team that has a domain you know, set of expertise in something that we don’t or, you know, has some sort of proprietary distribution. And I think those. Our opportunities for us to continue looking at businesses that might be appealing to us.
And those are some of the criteria that we might use to to evaluate them. But I think, you know, the reality is that most companies are always looking to see you know, what’s out there in the world and try to understand what it means for their own competitive positioning. So we will, I, you know, I’m quite certain that we will continue to add companies to the platform, but there’s nothing to announce here today.
Arundhati: You got me there. All right, Jeremy, thank you so much for spending some time with us at Med City Pivot.
Jeremy: Yeah. Thank you for having me. I appreciate it.