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Discovering the right balance in AI means blending cutting-edge technology with the core of human empathy.

“Artificial Intelligence is the compass guiding the healthcare industry towards a future where data-driven insights and innovation improve patient care, enhance operational efficiency, and lead us to a healthier and more equitable world.”

 – Definition provided by ChatGPT

During a session at the Texas Covered Conference titled “The Layered Approach to AI: Getting Practical to Create Better Operations and Empowered People,” Kevin Deutsch shared how AI can enhance health plans and the people they serve.

Linda’s Story: The Drive for Change

To innovate healthcare through AI, health plans should focus on crafting a positive experience for members.

The intersection of AI and empathy was shared through Linda’s story, a Medicaid recipient from a low-income household facing significant health challenges and a complex healthcare system. Her narrative highlighted the necessity of transforming healthcare into a cohesive journey rather than a disjointed series of tasks.

Deutsch contrasted Linda’s past experiences—marked by skepticism from providers, rushed consultations, and one-size-fits-all care—with a recent visit to a hospital with an interconnected care system. There, she met Dr. Jonathan Miles, an early adopter of AI.

Using AI to Create a New Kind of Healthcare Encounter

Linda noticed a stark difference with Dr. Miles. His attention was fully on her, his questions were thoughtful, and his care genuine. AI’s ambient listening and automated note-taking freed Dr. Miles from the distraction of manual tasks.

The session ended with Linda feeling recognized, understood, and hopeful for the first time in a long while.

This is AI’s role in healthcare—not as a replacement for human connection but an enhancer. AI can make healthcare more personal, compassionate, and effective. For Linda and many others, the tools used by Dr. Miles represent not a move towards impersonal automation but towards an era where the focus of medicine is care.

Understanding Payer Hesitancy Towards AI Investment

Integrating AI into everyday operations is a step that many payers don’t feel ready for.

Concerns range widely, from ensuring the privacy and security of patient data to fears of job replacement. And challenges like measuring the return on investment for AI technologies and constraints on resources prevent many health plans from moving forward.

These fears are understandable barriers that can stall progress. However, the risks of not investing in AI are far greater. The potential loss of not leveraging AI’s capabilities can be massive, considering the improvements AI can provide cross-departmentally.

Let’s review the three categories where AI has the greatest potential impact.

Gaining Consumer Insights

To provide better support, it’s essential to understand the drivers of patient behavior. AI opens the door to these insights, leading to customized services and communication.

Consider the multitude of interactions with consumers: website visits, customer service calls, plan enrollments, and bill payments. By learning more about consumers, much like companies such as Amazon and Netflix, healthcare providers can deliver superior experiences.

Potential benefits of new consumer insights include:

    • Enhanced personalization and tailored plan benefits.
    • A shift from reactive to proactive communication.
    • Faster decision-making powered by real-time data.

Improving the Consumer Journey

Let’s aim to make navigating healthcare as simple and intuitive as online shopping.

Just like Linda’s journey—full of appointments, follow-ups, and interactions—each touchpoint is an opportunity for enhancement. With industry burnout and staff shortages, AI could be the key to not only improving these experiences but also alleviating workforce challenges.

Potential benefits of an improved consumer journey include:

    • Higher customer satisfaction and retention rates.
    • Higher quality outcomes and reduced waste.
    • A competitive advantage and increased member acquisition.

Influencing Consumer Behavior

Insights help health plans guide members towards healthier choices and proactive health management.

In other industries, we often see subtle influences on our behavior, like product recommendations while online shopping. In healthcare, influencing patient choices is crucial for better health outcomes. By encouraging proactive care, appropriate plan enrollment, and efficient provider selection, overall health can be improved.

Potential benefits of influencing consumer behavior include:

    • Better ROI from marketing and engagement efforts.
    • More opportunities for cross-selling and up-selling.
    • A stronger brand that meets members’ needs effectively.

Opening the Dialogue Around AI Implementation at Your Organization

Without having those initial conversations, there’s no path forward . Softheon uses a strategic planning approach grounded in Objectives and Key Results (OKRs), advocating for a bottom-up strategy that begins by identifying the challenges faced by staff and members. It’s about understanding the investment required and the anticipated return on that investment.

Here are some tips for crafting your AI strategy.

Don’t Overlook Low Hanging Fruit

In crafting an AI strategy, the key is to identify and capitalize on the straightforward wins—those “low-hanging fruit” can provide significant improvements with minimal effort. The strategic assessment helps identify these chances. These might be issues that, once addressed, can benefit various stakeholders simultaneously, without having to dive into complex AI configurations.

However, it’s not uncommon for assessments to be shelved and forgotten. The key is to take action, even if it’s small. Begin with achievable targets that can quickly add value to your team and your members.

Build Gradually through Integration and Scaling

When introducing AI, think of it as a step-by-step renovation of a home. Just as you would plan for your current and future needs in a house, you should approach AI integration with a long-term vision in mind. It’s about adding value incrementally and ensuring each step has a meaningful impact.

The “layered approach” to AI suggests starting with basic applications and expanding to more complex systems over time. The success of each layer depends on the quality of input it receives, underscoring the importance of a strong foundation. With patience and ongoing refinement, the investment in AI is more likely to pay off.

Prioritize Ongoing Data Refinement

Good AI starts with good data. But you don’t need the most detailed and organized data to get started. Simple, consistent steps toward improving data quality can set the stage for more advanced AI applications.

Improving AI is a dynamic process that should include:

    • Evaluating the source and quality of the data feeding into the AI models.
    • Integrating AI tools into everyday operations.
    • Encouraging staff to actively use these tools, offering feedback to refine their function.
    • Continuously identifying and addressing gaps where the AI may fail, refining the model.

This ongoing cycle of evaluation and improvement ensures that the AI model evolves and improves over time.

Introducing Softheon’s AIME: AI for Efficient Healthcare Operations

At the end of the session, Deutsch introduced the audience to AIME, Softheon’s AI solution designed to simplify the complex world of healthcare documentation and operations.

AIME was designed to solve a seemingly simple problem that had a large impact on Softheon’s business: finding the right content to answer a specific question quickly. There was too much relevant content in Softheon’s database, that internal staff and external clients were having trouble getting to the answer quickly.

The solution? By integrating a ChatGPT-like interface with Softheon’s content library, AIME can guide users to their answers through a friendly and intuitive chatbot experience. Instead of navigating through a maze of search results, users receive straightforward responses.

AIME in Action

AIME isn’t just a Q&A tool; Softheon built onto that original concept and designed a range of features to enhance user interaction:

  • References to underlying documents for those seeking more details.
  • Acts as a co-pilot, guiding users through their queries and tasks.
  • Incorporates data visualization to present information in an easily digestible format.
  • Utilizes server-specific firewalls to ensure the security of customer data.
  • Integrates external data sources, such as client Standard Operating Procedures (SOPs), for a more tailored experience.

The potential applications for AIME are extensive. Soon, it’s set to not just be a tool for internal use but also a powerful resource for providers, members, and brokers, empowering them with information and autonomy.

To learn more about how health plans are getting started with AI, reach out to start a conversation.


All the images and story lines shared during the session were created using ChatGPT.