Analytics on the rise in healthcare payer BPS contracts
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The healthcare payer business process services market grew about 10% over the past year, driven in part by a shift in payers’ demand from cost reduction to more strategic, value-creating initiatives
Intelligent virtual agents’ (IVA’s) evolving capabilities: Key changes in the IVA market in the last 12-18 months are enabling IVAs to handle much more complex interactions which is driving the ability to serve specialized needs across industries and horizontals
I experienced three pleasant surprises at last week’s Healthcare Information and Management System Society (HIMSS) conference. They were all about a perfect storm that is building to correct all that has been wrong in the digital healthcare space all these years.
Healthcare Companies are Exploring Cures for Their #DigitalHeadache
Payers and providers alike are growing increasingly disillusioned with the outcomes of their digital programs. In fact, 78 percent of the healthcare leaders we surveyed in late 2018 indicated some sort of failure with their digital initiatives, whether big or small. The good news here is that most forward-thinking leaders are going back to the drawing board to redefine their digital strategy. Anthem, Intermountain Healthcare, and New York Presbyterian are great examples of organizations that have taken up the cudgels to fix digital healthcare where it fails – organization and culture.
There’s Increased Focus on “Enabling” the Patient Experience
To make the “patient experience” successful, enterprise leaders are taking a step back and focusing their attention on creating experiences for their workforce, clinicians, and partners (e.g., physician group, CMS, government agencies.) Don’t get me wrong, patients still need to be at the center of our universe. However, the personas that enable and deliver experience for patients need a fix first.
Innovation is Coming from Unexpected Sources
It was heartening to see the likes of Amazon, Google, Microsoft, and Salesforce steal the march from the big boys in the healthcare tech space – i.e., Cerner and EPIC – in asserting themselves as the technology visionaries in healthcare. Their focus on healthcare microservices is a relief for healthcare executives trying to navigate the “all or nothing” approach of the EMRs.
There is one player that seems keen on reinventing itself: Optum. Through a nimble product and services strategy, Optum is touching upon on all the hot buttons – MLR, analytics, PBM, and claims. Optum is the specialist vendor to watch out for when it comes to healthcare.
Last, but not least, what really took the cake were the innovative and exciting POCs related to clinical AI and visualization that Israel and Ireland – yes, the countries – showcased in their booths. These were some of the most fully baked solutions that I have seen in my 10 years attending HIMSS.
Hence, it’s with good reason that I left fairly impressed with the developing ecosystem knocking on the doors of healthcare organizations that are hungry for outcomes.
I will sign off by sharing an illustration from our recent study that analyzed the investments 27 of the leading healthcare payers and providers have made in artificial intelligence (AI), a key marker in the world of digital healthcare. This study objectively analyzed these investments from the perspective of ROI achieved.
As you can see, there is a wide variance even within such a small sample set of healthcare organizations. FOMO (Fear Of Missing Out) pushed a lot of organizations to invest in the flashy new toy called AI. However, not all of them embarked on their investment journey by first enabling the core components of capability.
The difference between the best and the rest in healthcare is simply this: the ones to get the best ROI – those on the top right – are taking their journey through step functions that enable not only technology but also an organizational culture of innovation.
Please contact me at [email protected] if you’d like to hear more about my take-aways from the HIMMS conference or our study, named “Dr. Robot Will See You Now: Unpacking the State of Artificial Intelligence in Healthcare – 2019.”
Assessments of payers and providers on their AI investments in healthcare: 27 healthcare players (payers and providers) assessed on their AI investments
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While the explosion of data, cognitive overload, endless documentation, and user burnout in the healthcare industry are driving demand for AI, it has implications far beyond technology: the majority of AI decisions impact business processes, customer experience, and cost – key concerns for chief executives
Demystifying Artificial Intelligence: Definition and Characteristics
New research predicts US$6 billion investment will drive innovations in patient identity verification, opioid abuse detection and individually tailored healthcare.
Healthcare organizations are pouring billions into embedded AI across the value chain, driving an estimated quadrupling of AI investments in the next three years, according to Everest Group. The firm predicts that healthcare AI investments will grow from US$1.5 billion in 2017 to exceed US$6 billion by 2020, representing a compound annual growth rate of 34 percent.
While AI is a relatively new area in the healthcare space and its adoption is in the nascent stage, digitalization of healthcare is accelerating healthcare enterprises’ interest in AI. AI has the potential to transform healthcare processes and dramatically reduce costs and improve efficiencies.
For example, healthcare payers are leveraging AI for product development, policy servicing, network management and claims management. Examples include:
- Use of fingerprints, eye texture, voice, hand patterns and facial recognition to reduce the time taken for customer verification
- Leveraging of machine learning with integrated claims data and analytics to detect opioid use patterns that suggest misuse
- AI-powered wearable devices and mobile applications to help customers with personalized advice
- Chatbots and virtual assistants to predict the right answer to standard customer inquiries and assist customers in navigating through the insurance plan selection process.
Currently, the area where payers are adopting AI to the greatest extent is in care management.
Likewise, the highest adoption of AI by healthcare providers is for care and case management. Providers also are employing AI tools to:
- collaborate more effectively with patients
- reduce the time required for aggregating, storing, and analyzing patients’ data
- streamline workflows
- monitor patients remotely
- detect diseases faster and more accurately
- come up with better treatments.
These findings and more are discussed in Everest Group’s recently published report, “Dr. Robot Will See You Now: Unpacking the State of Artificial Intelligence in Healthcare – 2019.” The firm has analyzed the market from the vantage point of 27 leading healthcare enterprises and closely examined the distinctive attributes of the leaders, who are far ahead of the other industry participants in terms of AI capability maturity. The report identifies best practices, illustrates the impact generated, and offers proposed a roadmap for market stakeholders.
***Download a complimentary abstract of this report here. ***
“While healthcare enterprises are still in the nascent stages of AI adoption, the scale of opportunity in AI demands C-level vision,” said Abhishek Singh, vice president of Information Technology Services at Everest Group. “AI presents unique opportunities for healthcare enterprises – allowing them to improve customer experience, achieve operational efficiency, enhance employee productivity, cut costs, accelerate speed-to-market, and develop more personalized products. In the case of the leading healthcare organizations, their CEOs and CIOs are acknowledging the transformative power of AI, rapidly building appropriate AI strategies, and building a robust, overarching business plan to harness its benefits.”
Additional key findings:
- Nearly two-thirds of spending on AI in healthcare is driven by North America. The North American market is also expected to be the fastest growing during the next five years, driven by regulatory mandates for use of electronic health records, increasing focus on precision medicine and a strong presence of service providers engaged in developing AI solutions for healthcare.
- Around 75 percent of all AI initiatives in healthcare are still driven by large enterprises as most mid- and small-sized firms are taking a wait-and-see approach.
- With a boom in enterprise AI, talent scarcity has become one of the biggest leadership challenges in implementing and evolving AI capabilities.
- Application of machine learning (ML) for structured data and natural language processing (NLP) for unstructured information have become mainstream in the healthcare industry.
- Cognitive technologies are expected to play an important part in health plans’ technology strategies going forward. Also, providers are looking to increasingly leverage deep learning to explore more complex, non-linear patterns in data, such as that found in research papers, doctors’ notes, textbooks, clinical reports, health histories, X-rays and CT and MRI scans.