Artificial intelligence (AI) has the power to broadly transform operations across the healthcare industry.
That includes helping health plans and providers automate case reviews and access relevant clinical data for individual patients in real time. AI also supports more effective utilization management in healthcare and case management in hospital settings. It helps decision-makers reach a more objective determination of medical necessity.
There are foundational advantages to consider, too, like reducing the burden of data entry.
AI Has a Broad and Powerful Influence on Healthcare
AI is a broad umbrella of far-reaching, transformative technologies that can play important roles in:
- Clinical data management
- Data collection
- Provider training
- Many more areas of operation, both clinical and administrative
PwC identified eight foundational areas where AI, along with robotics, fundamentally changes operations and outcomes.
One of the most important benefits that AI can provide is more positive and effective relationships between healthcare partners. Let’s look at a few examples of AI supporting better collaborative outcomes for hospitals, health systems, payers, and patients.
Reducing Friction Between Healthcare Partners and Making Relevant Data More Available for All
Providing the best possible patient care is a top priority for providers, from the individual clinician to entire health systems. Effectively communicating and collaborating with its payer network, and helping them see the same information that supports clinical decisions, is crucial.
AI can improve outcomes in this regard. How? By making data more readily and easily accessible without significant effort on the part of any staff members. Providers can leverage AI solutions, such as XSOLIS’ CORTEX platform, to create a collaborative environment for case review.
AI has the power to parse through vast amounts of information in the electronic medical record and bring the most immediately relevant information to the forefront. That makes it easier for payers to focus on the right details and move past the volumes of data in an EMR, not limited to PHI, but which could also include unstructured data like written notes and documents, labs, vitals, meds, and more. It also reduces the need for phone calls and emails for clarification.
Prioritizing the Most Important Patient Needs
Effective delegation and priority setting are the foundation of an optimized approach to providing patient care.
AI supports clinicians by conducting in-depth analysis and highlighting cases where patients present with the highest levels of acuity. By generating a Care Level Score using consistent metrics, healthcare providers have dependable, evidence-based parameters to guide their decision-making: the higher the score, the more likely the patient aligns with inpatient status, while lower scores indicate a lower likelihood, or more appropriate for observation. This helps highlight revenue sensitive cases, so the staff can take appropriate action.
At the same time, AI reduces the burden of manual administrative work like data entry. That can give nurses, doctors and other practitioners more time back in their days to focus on the individual needs of patients, which XSOLIS customers commonly estimate as around two hours per user per day.
With the improved payer communications mentioned above, it’s even possible for providers to facilitate a better relationship between patient/member and payer, since any delays or denials adversely affect not only the hospital but the patient experience as well. While improving member relationships with their government payers or private insurers is not a priority for hospitals and health systems, it is yet another example of how AI fosters better relationships between healthcare partners, and can also result in improved patient satisfaction.
Transform your hospital or health system and its relationships with its healthcare partners through the power of AI: Get XSOLIS for your organization.
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