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In a rapidly evolving technological landscape, the potential for innovative solutions to transform healthcare is at an all-time high.  

Eugene Sayan, Founder and CEO of Softheon, shared, “Years ago, we were promised autonomous cars… but along the way, we have been introduced to AI technologies such as LIDAR and blind spot detections. In healthcare, we are watching a similar evolutionary process take place in many areas.” 

During a session at HLTH2023 titled “Harnessing AI & Analytics as a Force for Good,” a panel of experts from Kaiser Permanente, 10Pearls, and Softheon discussed the impact of AI and advanced analytics on revolutionizing payer operations and patient care.  

Improving Payer Operations for a Better Member Experience: 3 Use Cases for AI 

The panelists discussed how technology partners are working with payers to make the insurance navigation and decision-making process for consumers more intuitive and less complicated. 

As Sayan pointed out, “[Choosing] the correct health plan is probably one of the most complex and most troubling experiences for any consumer.”  

Drawing from his experience managing the shopping, enrollment, and billing operations on the ACA Marketplace, Sayan elaborated on the three primary areas of AI interest for health payers: 

1. Improving the Consumer Journey: 

Payers continue to work towards creating a seamless and user-friendly experience for members, making healthcare as effortless as shopping on e-commerce platforms, similar to experiences provided by companies like Amazon. AI is being used to automate manual processes, optimize employee performance, and focus on the member’s needs and preferences. 

2. Gaining Consumer Insights: 

To better support consumers, it is crucial to understand what drives their behavior in healthcare. AI and data analytics can help uncover those underlying motivations and preferences of members. By collecting and analyzing data on patient behavior and preferences, services and communication strategies can be tailored to better meet the needs of members. 

3. Influencing Consumer Behavior: 

Armed with insights into patient behavior, payers can use AI to promote positive healthcare choices. This can involve personalized recommendations, reminders for preventive care, and targeted interventions for chronic disease management.  

Enhancing Provider Interactions with AI: A 5-Pillar Strategy from Kaiser Permanente 

Dr. Ainsley MacLean, Chief Medical Information Officer at Kaiser Permanente, outlined a five-pillar approach for healthcare organizations to integrate AI into their operations and patient experiences. MacLean noted the involvement of key stakeholders, particularly physicians, is critical for the success of AI initiatives.  

Let’s explore each of these pillars in more detail: 

1. Ambient Listening: 

Ambient listening involves using AI technologies to passively capture patient data during interactions, such as doctor-patient conversations. This allows healthcare professionals to concentrate entirely on the patient during examinations and consultations. By automatically recording and transcribing important information, AI reduces the administrative burden on physicians and ensures that no crucial details are missed. 

2. Patient Portal and Remote Monitoring: 

Using AI to improve the patient portal and remote monitoring allows for faster access to healthcare services. Healthcare providers are leveraging AI to create user-friendly patient portals, allowing individuals to schedule appointments, access their health records, and communicate with their healthcare team. Remote monitoring solutions enable healthcare professionals to track patient health data in real-time, allowing for more personalized and timely care interventions.  

3. Electronic Medical Records (EMR) and Electronic Health Records (EHR): 

Kaiser Permanente’s strategy includes using AI to streamline and optimize workflows related to EMRs and EHRs. AI can help organize, categorize, and extract critical information from these records, making it easier for physicians to access relevant patient data. Additionally, AI can streamline routine administrative tasks, freeing up healthcare professionals to focus on patient care. 

4. Medical Imaging: 

Leveraging AI in medical imaging, such as radiology, cardiology, and gastroenterology, aids in the early detection of diseases and reduces the likelihood of missed diagnoses. Challenges like false positives exist, so it’s essential to understand that AI is not intended to replace physician expertise but rather complement it. AI is fast becoming an indispensable tool for healthcare providers, enhancing diagnostic accuracy and efficiency in these critical medical fields. 

5. Business AI: 

Business AI focuses on the strategic use of data analytics in healthcare management tasks. By harnessing the power of data analytics, healthcare leaders can gain valuable insights into their business processes, including financial management, resource allocation, and patient outcomes. Business AI is instrumental in making data-driven decisions and achieving operational efficiency. 

Implementing AI in Your Organization 

While AI offers immense potential in healthcare, many organizations grapple with uncertainty about where and how to begin their AI journey. Amir Azarbad, Managing Director of Healthcare at 10Pearls, shared insights on successful AI implementation.  

Azarbad emphasized the importance of identifying the most relevant use cases for AI and analytics to drive meaningful change, specific to your organization. Additionally, he stressed the importance of obtaining employee buy-in, highlighting the need to communicate that AI deployment is a strategic enhancement, not a mass job replacement. 

To learn more about the challenges payers will face when undertaking AI initiatives – and how to overcome them – download Softheon’s Guide to Navigating the AI Revolution.