What Will AI Do for Health Care?

Enhanced Uses of Generative AI in Healthcare

The healthcare landscape is a unique blend of scientific inquiry, compassionate care, and the intricacies of healthcare administration. Navigating the demands of analytical precision, empathy, and economic considerations presents a constant challenge. I take pride in contributing to an industry where dedicated professionals strive to refine the delicate balance of these three components.

In the evolving landscape of generative AI (Gen AI) beyond 2024, its primary impact will be in augmenting our comprehension of scientific, human, and business aspects within healthcare. This holds significance for healthcare regulators seeking to integrate and deploy innovative technologies. It resonates with researchers and healthcare practitioners aiming to deepen their understanding of patients and enhance treatment methodologies. Simultaneously, it addresses the needs of healthcare organizations and millions of patients seeking more equitable and effective care.

In the short term, our focus will be on cultivating this enhanced understanding, with the hope that sustained effort will lead to a profound transformation of knowledge in the long run.

1. Healthcare Management:

• Synthesize clinical notes for care managers.
• Generate care plans and summaries for members.
• Provide custom coverage summaries for specific benefit inquiries.
• Deploy adaptive chatbots for service queries.
• Suggest clinicians based on parameters like coverage, location, preferences, and conditions.

2. Member Services:

• Create personalized coverage summaries for benefit queries.
• Generate call scripts for outbound nonclinical communications.
• Deploy adaptive chatbots and smart routing for service questions.
• Suggest clinicians based on specific parameters.

3. Provider Relationship Management:

• Compare plan/product features and networks.
• Generate standard communications (welcome letters, reports, etc.).
• Summarize gaps in provider directories and update open panels.
• Generate performance reports for providers and vendors.

4. Corporate Functions:

• Generate HR self-serve functions and onboarding materials.
• Synthesize requests for proposals (RFPs) and draft responses.
• Automate accounting processes by extracting relevant numbers.
• Provide large-scale coverage updates for policyholders.

5. Claims Management:

• Generate summaries of manual and denied claims for issue resolution.
• Aggregate information for complex claims to reduce processing time.
• Autogenerate summaries and outcomes for prior authorization requests.

6. Marketing and Sales:

• Analyze consumer distribution for personalized plans.
• Summarize customer feedback to improve products and services.
• Enhance sales support/chatbots to assist potential members.
• Create initial materials and overviews for brokers.

7. Hospitals and Physician Groups:

• Summarize discharge information and follow-up needs.
• Generate care summaries for referrals.
• Synthesize specialist notes for primary-care physicians.

8. Quality and Safety:

• Recommend tailored risk considerations based on patient history.
• Synthesize data for patient education materials.

9. Value-Based Care:

• Improve documentation accuracy using structured and unstructured data.
• Draft standard value-based care and carve-out contracts.

10. Reimbursement:

- Develop prior authorization documentation for payers.

- Automate coding and checks based on physician notes.

11. Clinical Operations:

- Generate post-visit summaries and instructions.

- Create educational materials on disease identification and management.

12. Corporate Functions (IT, Procurement, Talent, Finance, Others):

- Assist in code development and cybersecurity testing.

- Draft RFPs, contracts, and vendor communications.

- Generate financial reports and key performance indicators.

13. Clinical Analytics:

- Leverage conversational language for obtaining analytics insights.

- Use AI-assisted coding to automate repetitive tasks.

14. Consumer Engagement:

- Analyze customer feedback to improve services.

- Create personalized care instructions, videos, and communications.

- Enhance chatbots for member servicing.

Strategically, the application of Gen AI in healthcare revolves around redefining value in four primary business categories:

1. Amplified Experience:?Facilitating digital contact centers.
2. Intelligent Workflows and Processes:?Managing the financial aspects of the digital workforce.
3. Advanced Analytics and Intelligent Insights:?Enabling clinical recommendations and targeted interventions.
4. Streamlined IT:?Modernizing code and infrastructure for enhanced efficiency.