A new Becker’s Healthcare article takes a closer look at the partnership between Shields Health Solutions and Foundation Health
Shields Health Solutions and Foundation Health Partner to Bring AI to a Rapidly Evolving Specialty Pharmacy LandscapeWhen 94% of providers report care delays tied to prior authorization requirements (AMA), specialty pharmacy leaders face a defining question: how do you scale without losing high-quality patient care and the human touch?For Shields Health Solutions, which integrates specialty pharmacy operations across nearly 80 health systems nationwide, that question naturally moved to the forefront. Built on a care model that balances clinical excellence and operational efficiency, Shields saw an opportunity to help health systems scale thoughtfully without adding staff or compromising patient care.Technology was the obvious answer. While Shields’ connected performance platform already links health systems, clinicians, and patients, the next step was finding a technology partner that could bring advanced AI capabilities into that platform while keeping human touch at the core of what they do.After evaluating nearly every pharmacy AI solution on the market, Shields selected Foundation Health. The framework that led to that decision, along with early results demonstrating up to 50% reduction in manual prior authorization effort, provides a practical roadmap for other health system leaders navigating AI adoption.The Selection Framework: Three Non-negotiable CriteriaShields approached AI adoption as an infrastructure decision rather than a software purchase. Leadership defined upfront what a long-term partner would need to deliver across a complex, multi-health system environment, centering on three non-negotiable criteria:1. Deep Specialty Pharmacy Expertise: Many AI solutions addressed isolated workflow steps rather than end-to-end specialty pharmacy operations. Shields required a partner with proven health system deployments and deep understanding of the full patient access journey.2. Workflow-Native EHR Integration: The solution had to embed directly into Epic, Cerner, and other leading EHR platforms across 80 diverse health system environments, operating inside existing clinical workflows, not alongside them.3. Partnership Structure with Shared Accountability: Beyond software licensing, Shields made a strategic investment in Foundation Health, establishing a co-development model where both organizations are aligned around long-term performance and measurable outcomesFoundation Health emerged as the partner that best aligned with this framework, reflecting Shields’ belief that technology should enhance, not replace, the specialized expertise of pharmacy teams.“This partnership allows us to start addressing ways AI can meaningfully optimize workflows without sacrificing the human touch that is central to our differentiated care model.” said Michael Ham, CEO of Shields Health Solutions. “Our partnership with Shields reflects a shared commitment to building durable systems that improve patient access while supporting the teams delivering care every day,” said Umar Afridi, Founder and CEO of Foundation Health.Partnership in Practice: AI that Works Alongside Clinical Teams and Within Specialty Pharmacy WorkflowsTogether, Shields and Foundation Health are addressing one of specialty pharmacy’s most persistent challenges: the administrative burden and delays that slow patient access to therapy.With the long-term roadmap extending across the entire patient access journey, the initial focus centers on prior authorization (PA) automation.In practice, Foundation Health’s platform:
- Pulls relevant patient and clinical data directly from the EHR
- Streamlines payor specific forms and documentation
- Submits and tracks prior authorization requests
- Surfaces status updates within the systems pharmacy teams already use
