How Healthcare Organizations Are Leveraging AI

The applications for artificial intelligence (AI) in healthcare continue to expand, as evidenced by the proliferation of AI use cases across all segments of the industry, as well as by the explosion of start-ups focused on leveraging AI to address a broad array of challenges. A July 2020 survey conducted by Accenture reported that 69% of healthcare organizations are piloting or adopting AI solutions. We are seeing an infusion of AI in care delivery, RCM, process re-engineering, and also directly in the care setting with the development of highly sophisticated ambient sensors. 

ChasmPOV

AI is at the dawn of a new era in healthcare and many organizations are experiencing impressive results as the power of technology enhances effectiveness and efficiency. In addition to the abundance of trade news on the topic, I’ve recently had the opportunity to discuss AI with innovative companies on the forefront of applying AI to healthcare and achieving validated results. A few highlights of my conversations and readings follow: 

• AI innovation and low-cost, contactless sensors have led to an ambient intelligence that can potentially improve the physical execution of healthcare delivery by illuminating the “dark, unobserved spaces of healthcare,” according to a September 2020 Nature Research article authored by Albert Haque, Arnold Milstein, and Li Fei-Fei. The authors discuss very compelling use cases for AI to provide critical visibility into healthcare activities that occur in the patient’s home, a hospital room, and senior living facilities. In the hospital setting, employing ambient intelligence to monitor patient mobilization could reduce the incidence of ICU-acquired weaknesses. Applied to the senior living space, contactless, ambient sensors can improve detection of a patient’s ability to perform ADLs and reduce fall risks. The potential for this type of technology is expansive – there are multiple applications in the acute care and senior living settings, as well as chronic condition management, mental health, and even clinical trials.

• Today, hospital mid-revenue cycle management encompasses multiple steps across clinical documentation, coding, charge capture, pre-bill reviews, and other claims preparation processes. However, to do this accurately and compliantly requires extensive clinical knowledge and huge teams of coding specialists. To solve these challenges, Iodine Software has pioneered a new approach called Cognitive Emulation™ which uses proprietary AI technology and machine learning algorithms to "think" the way a clinician thinks. Iodine’s Cognitive Emulation approach powers the AwareCDI Suite, which delivers clinical documentation reliability and a significant reduction in condition and revenue leakage across the entire mid-revenue cycle. Iodine works with nearly 500 hospitals to quickly and accurately identify areas of potential opportunity, helping them identify $1.5B additional appropriate reimbursement (nearly $6M per hospital annually).

• Prealize Health applies advanced, clinically informed AI to solve critical business challenges across healthcare organizations. Their AI-powered proactive member-level insights uniquely predicts why a member will rise in risk and cost, and gives payers broad versatility in powering every step of healthcare journey,  such as predictive pricing, personalized communications, innovative benefit and network design, program engagement, and health equity. Prealize’s trustworthy ML predictions are 2x more accurate than any other predictive solution, giving payers the confidence needed to make business and clinical decisions against them. Prealize allows payers and providers to take action and impact health and cost trajectories by providing member-level insight 6-18 months before a diagnosis hits a claim, before a member gets sick, and before cost occurs. This solution transforms clients from reactive to proactive by leveraging different types of data including, but not limited to, medical and Rx claims, case management, lifestyle/consumer, and Social Determinants of Health. 

The universe of established players and new entrants in the AI space is extensive and broadening weekly with news of venture activity and M&A. We are at the forefront of the AI revolution in healthcare and expect continued innovation and disruption as the technology advances.