By Valerie Barckhoff, principal and healthcare advisory practice lead, Windham Brannon.
Hospitals and health systems throughout the country are constantly looking for ways to streamline finances and fine tune operating margins. Many are now looking outside the box for solutions to help increase their operating revenue and combat the continued pressure to stretch budgets to include data security, attracting top talent and facility upgrades. Artificial Intelligence (AI), as an example, is showing promising results in healthcare to more effectively address revenue cycle inefficiencies.
AI has penetrated nearly every touchpoint in medicine, from the way emergency medical technicians (EMTs) are dispatched to assisting physicians during surgery. AI is enabling smart devices to detect cancer or a stroke, and consumers can even get help to quit smoking or address opioid addictions with the help of AI. So, it was only a matter of time to apply AI to tackle health revenue cycle inefficiencies. But how?
RCM Represents Prime Opportunities for AI
Even as revenue cycle management (RCM) becomes increasingly more complicated, there are a number of repetitive and predictable processes involved that make it an area perfect for the efficiencies that AI and intelligent automation offer?for instance, prior authorizations.
Prior authorizations, the process by which insurance companies and payers determine if they will cover a prescribed procedure or medication, are meant to help patients avoid surprise bills and unexpected out-of-network costs. However, this largely manual process is time-consuming and error-prone, resulting in $30 billion in annual costs for wrongful denials, inefficiencies and clerical errors. AI can reduce the need to assign resources to repetitive, “simple” pre-authorization requests, allowing healthcare leaders an opportunity to deploy staff to more complex, acute requests that require additional clinical information, peer-to-peer review, and/or other payer required information
Studies show that 84% of physicians surveyed said the burdens associated with prior authorization were high or extremely high, and 86% said the burdens associated with prior authorization have increased significantly (51%) or increased somewhat (35%) during the past five years.
The ability to apply AI to the revenue cycle provides yet another tool to identify inefficiencies, then allow hospitals to redesign their processes and re-allocate internal resources to maximize their net revenues going forward? to focus on more patient care instead of administrative burdens. There is a huge opportunity to gain 25- to 50-percent efficiencies for hospitals and health systems.
Artificial intelligence is poised to make a major impact on healthcare and healthcare technology. Investment in the healthcare AI sector alone is predicted to reach $6.6 billion by 2021. By 2026, that number will balloon $150 billion. And there’s no doubt about the transformative power of artificial intelligence, however, in terms of healthcare, its restorative effects are truly life changing.
Today, there’s a term in healthcare called the “iron triangle.” The iron triangle refers to three combined factors that can have negatives trade offs: affordability, access, and effectiveness. Though closely interlocked, improving one area without neglecting another is very difficult—even in modern times. With AI, the healthcare is much better equipped to tackle these conundrums. Here’s how artificial intelligence will impact the future of healthcare tech:
One of the biggest benefits of AI in healthcare is the ability to predict potential issues and eradicate them before they become too serious. Machine learning is a major part of prevention intervention. With machine learning, computer systems are handed data and use statistical techniques to identify patterns over time and “learn” more about the information it processes. Doctors can use these targeted analytics to make more accurate diagnosis, spot potential issues before they arise, assess risks, and offer better treatment plans.
By Adarsh Jain, editor, Transparency Market Research.
A rosy picture is always a tricky perception. Artificial Intelligence or AI as it is known, is also very similar. Research publications are inundated with the findings that integrate AI with industry for better outcomes. And in most cases, these findings prove to be worthy in one way or other. But, the picture for healthcare is not as rosy as it seems to be. While tech companies across the world have invested in developing products that will assist the practitioner in making better decisions, doctors have their own doubts in implementing them. Despite these doubts, there is enough hope for players in an upcoming market like AI in healthcare, finds a Transparency Market Research study.
Will AI take away jobs?
In most industries, this has been the million dollar question. And, as serious as it may sound, experts have, time and again, clarified that AI is not going to take away jobs. It, of course, will augment decision-making and, thus, help produce better outcomes. Healthcare should be no different.
Before medical practitioners make a hasty call, it is important for them to realize that AI is a machine, and it clearly works based on algorithms. A machine does not have a human brain to be able to take conscious decisions. It, however, is only a critical aid in taking better decisions. There is no doubt that a large pool of data on admissions, medical history, procedures, conditions, etc. remains untouched across the world, states the TMR study. Processing and inferring from this large a pool of data is humanly impossible. This is where AI can aid physicians. What has happened is that the use of AI has affected radiologists and pathologists the most. For long, these two healthcare professionals have been the backbone of discerning abnormalities in human body functions or detecting conditions.
While healthcare organizations and experts, including government representatives, have proposed the use of AI in diagnosis, the risk of misjudgment bothers medical professionals. A wrong diagnosis or treatment could result in loss of life, and invite severe action against the healthcare professional. This argument from the healthcare professionals hold weight and, perhaps is a strong emotional reason for doctors from being reluctant towards introducing AI in their practice.
Lack of regulations is the caveat
A process bound by regulations is always more effective. In most countries, there is no law that defines the use of AI in medical practice. There is hardly any information that speaks about the limit to which the use of AI should be restricted. Also, the lack of information on the right usage, and ensuring all inferences or decisions based on AI are error-free is a huge caveat.
At a time when tech giants, especially in the United States, are vigorously working towards rolling out AI in healthcare, it is prudent to have regulations that define usage. It is just the matter of one country making the move, and when that happens, the rest are likely to follow suit, states the TMR report.
Artificial intelligence is a topic that should interest us all – as it revolutionizes the world with every second and in unimaginable ways. And the healthcare system is one of the areas that AI has already started to revolutionize. These are the main ways in which that is happening.
To read the full article I wrote recently, visit MedSource Consultants’ website.
The world of healthcare is changing and those changes impact how we deliver care, our approach to engaging patients and the relationships between stakeholders across the healthcare value chain. Each day, we witness advances in genomics, imaging and pharmacology, and learn about the use of artificial intelligence (AI) to drive these advances. Indeed, healthcare is in the midst of a major revolution and AI seems to be at the very core of this transformation. How much of the AI story is hype and how much is real?
Innovaccer Inc., a San Francisco-based healthcare data activation company, is hosting a breakthrough AI webinar on June 20 with guest speakers Dr. Peter Lee, corporate vice president, Microsoft Healthcare, and Stephen K. Klasko MD, MBA, president and CEO, Thomas Jefferson University and Jefferson Health, who will be discussing the new healthcare domains of AI, and it’s “never imagined” impact. They will be joined by webinar moderator, David Nace MD, chief medical officer at Innovaccer.
The use of AI in healthcare has lagged behind other industries, in large part because of the lack of comprehensive, pristine data. The webinar, titled “Beyond Interoperability: Data Activation and Artificial Intelligence for Healthcare,” will focus on the recent AI hype, tease fact from fiction, and explain how advances in data activation can solve the accuracy and interoperability problems in the space.
Dr. Lee has extensive experience in managing the process of going from basic research to commercial impact. Past illustrative examples include the deep neural networks for simultaneous language translation in Skype, next-generation IoT technologies, and innovative silicon and post-silicon computer architectures for Microsoft’s cloud. He also has a history of advancing more “out of the box” technical efforts, such as experimental under-sea data centers, augmented-reality experiences for HoloLens and VR devices, digital storage in DNA, and social chatbots such as XiaoIce and Tay.
Lee is a member of the board of directors for the Allen Institute for Artificial Intelligence and the Kaiser Permanente School of Medicine. He served on President’s Commission on Enhancing National Cybersecurity. And, previously, as an office director at DARPA, he led efforts that created operational capabilities in advanced machine learning, crowdsourcing, and big-data analytics, such as the DARPA Network Challenge and Nexus 7.
Under Dr. Klasko’s leadership, Jefferson Health has grown from three hospitals in 2015 to 14 hospitals today. His 2017 merger of Thomas Jefferson University with Philadelphia University created a pre-eminent professional university that includes top-20 programs in fashion, design and health professions, coupled with the first design-thinking curriculum in a medical school, conducting the nation’s leading research on empathy, an essential component of medicinal practice that is often overlooked in the academic setting. As a disruptive leader in the academic ecosystem, Dr. Klasko brings a valuable point of view to the Innovaccer Strategic Advisory Council.
By Jean Turgeon, vice president and chief technologist, Avaya.
By 2020, healthcare spending around the globe is expected to reach $8.7 trillion, and as part of this spend, healthcare providers are looking to digitally transform by innovating legacy processes and driving better patient experiences. With recent advances in customer-relationship management (CRM), and electronic health record (EHR) technology, providers have an opportunity to significantly update communication channels for patients to reach them.
For patients, the first point of contact with a hospital is essential, whether they’re seeking assistance for a serious health risk or checking in with a doctor. Communications infrastructure plays an integral role in the delivery of this care. By utilizing popular technologies already in patients’ hands, such as smartphones, social media and instant messaging, providers can easily contact patients and offer support above and beyond the traditional telephony services offered. Beyond this, providers can implement AI to connect these channels and create a holistic profile for patients – seeing where and when they reach out for support, and mapping resources to fulfill these needs.
This connected health approach, creates efficiencies by pooling and analyzing data that is beneficial to both healthcare providers and patients. For instance, AI can be used to quickly match appointments for patients with specialists or doctors who have office hours that best align with their schedule. The benefits of this are two-fold, first in time-savings, second in literal savings, as every missed appointment or open time slot averages $200 lost for the healthcare provider.
In addition, third-party applications can be integrated and used to create a custom service that aggregates data and populates a profile for the patient, including financial information, insurance details, demographics, and medical history into the EHR system. By connecting data-sets, and taking the administrative tasks away from hospital staff, AI elevates burdens and streamlines the appointment and admission process. This intuitive profile building, and patient-physician matching can extend to critical situations, such as an ER visit.
Using connected communication solutions, an ER physician can automatically trigger messages to key personnel when admitting a patient, just by placing an order in the EHR system. For instance, a bed placement specialist will be alerted of the patient-need, and can determine if a bed is available. Or, a message can be sent to the transport team to collect and guide the patient.
Moving beyond the check-in and doctor assignment process, patient alarms and bedside requests can be advanced beyond the simple “click-and-wait” approach of many healthcare providers. Automated workflows combined with AI-enable technology, such as speech enabled self-services, can be used bedside to ensure patient requests are routed efficiently to the appropriate hospital staff. In practice this will mean fewer delayed treatments, and greater patient safety and satisfaction. Rather than the on-call medical staff being alerted to the bedside for a pillow request, a smart workflow could alert hospitality staff to deliver a pillow to the room and eliminate the need to go back and forth. Not only would this stop physicians having to relay messages to other team members, slowing the speed of assistance, it will ensure that appropriate staff are tapped for appropriate patient-needs – streamlining workflows and efficiency.
We are quickly moving to a patient-centric world in healthcare where treatment is coming to the patient, the patient is treated more like a customer, and medical facilities of all types must use technology from the business sector. Business sector software designed to improve the customer experience can now be used to improve the patient experience. No technology is driving this shift faster than artificial intelligence (AI). AI is propelling us into an increasingly digital medical experience where patients expect personalized experiences that take into account their individual needs and values, and empower them to get information fast and accurately.
Prescription drugs are ground zero for AI innovation
Although AI has been touted for everything from diagnosis to automating medical imaging to drug discovery, we believe that ground zero for AI innovation in patient-centric healthcare is prescription medicine. Prescribers and patients are suffering in countless ways from the complexity and associated errors in prescriptions.
A single drug has hundreds of factors that must be considered by a doctor or a pharmacist when prescribing or dispensing a drug to a patient. We examined 50 of the most popular drugs and found that the average number of considerations for a single drug is enormous:
2018 was another year of rapid changes in the healthcare industry. Over the past twelve months, I’ve had fascinating conversations with executives in the provider and payer community and they have described the challenges they face and their visions for the future. One thing has become clear among everyone in the healthcare ecosystem: expectations are changing.
Patients are looking for a retail-like experience for their treatment, and sure enough, a number of new, innovative providers are gaining traction by leading with convenience and patient-centricity. Patients are embracing alternatives to the traditional doctor’s office or the local hospital. Unwilling to wait for an appointment, patients are eager for more responsive, high-quality treatment options.
Healthcare providers are becoming more innovative in an effort to improve the quality and efficiency of patient care while continuing to look for ways to reduce costs. Payers are exploring new approaches to improve their back-office systems and are willing to partner with third-party vendors to accelerate this improvement, rather than trying to develop everything in-house.
I am confident that this year will be full of important change in the industry and that these changes will touch the lives of millions. Of course, there is still a long way to go since the healthcare industry is historically slow to embrace change – it is often difficult to break through a culture that normally stays with the status quo. However, the desire for change is definitely there. If I were to list my top three predictions for trends in healthcare in 2019, they would include the following:
1) Health plans will get much more serious about improving member experience and predictability.
Health plans are eager to improve their member experience, partially because of the emergence of new consumer-centric plan models. As the market becomes more competitive with new entrants, traditional health plans will continue to partner with agile startups to deliver an improved member experience. These partnerships will enable health plans and startups to pilot projects and scale them quickly, leveraging the strengths of both organizations.
2) Employers are focusing on providing access to targeted healthcare solutions that meet specific therapeutic needs.
As of 2018, 83 percent of employees say healthcare is very or extremely important to/for staying in a job or changing a job. Given the importance of healthcare to their employees, and that the average company spends $10,000 on healthcare annually for each worker, employers will recognize the need to invest in specific solutions in areas where traditional networks fall short. These include programs for infertility, women’s health and behavioral health.