- The payer ecosystem has changed significantly over the past several years, creating an increased need for AI solutions in the back office.
- Complex patient needs often require higher-touch care, and organizations could use AI to support these patients without ramping up the burden on clinical and non-clinical staff.
- Providers should focus on the financial fundamentals, including short- and long-term ROI, to make financially sound decisions when investing in AI solutions.
Digital transformation across healthcare has accelerated in recent years, driven by the increasing availability of advanced, personalized treatment options and patient demand for seamless, convenient care. Meeting complex patient needs isn’t just about attracting and retaining patients — though it’s certainly important for that — but also for maximizing healthcare organizations’ financial performance, as more and more payers shift to outcome-oriented, value-based care.
Healthcare organizations have access to new technologies to anticipate and meet patients’ needs. Artificial Intelligence (AI), in particular, may have the potential to enhance the patient experience and boost ROI by driving efficiencies and unlocking additional revenue opportunities.
Here, we’ll discuss how AI may help health systems navigate complex patient journeys. And, how healthcare organizations can set themselves up to maximize ROI with AI-powered solutions.
AI and the patient experience
Increasingly complex patient journeys pose new challenges for managing the patient experience. Today’s patients expect providers to have access to holistic patient records, and be able to identify and anticipate their needs when they arrive at an appointment. They’re also looking for seamless care across interdisciplinary care teams — even if those teams are located in different locations.
AI may play a pivotal role in helping healthcare organizations meet these expectations. It may help automate data management, allowing healthcare providers to quickly attach patient data to the correct Electronic Health Records (EHR) to help ensure continuity of care between providers. AI-driven data analysis may also predict patients’ needs based on their demographic information and health records, so healthcare organizations can offer tailored support — for example, phone calls with a nursing team or in-home visits — that may help keep patients engaged in their care.
Deploying these technologies effectively may help unlock revenue opportunities by allowing healthcare organizations to attract and retain patients with an exceptional patient experience. And, importantly, it helps providers offer tailored, personalized care and support, helping to enhance patient outcomes along the way.
Maximizing reimbursement amid value-based care models
The payer ecosystem has changed significantly over the past several years, marked by shift away from volume-based reimbursement toward value-based care. This means that the primary goal for healthcare organizations — maximizing outcomes for patients — now also directly benefits an organization’s bottom line.
Leveraging AI-powered tools may help organizations more effectively deliver care to enhance outcomes for patients — and consequently, maximize reimbursement from payers. AI may review patient data, for example, to identify at-risk patients, creating opportunities for organizations to be proactive in monitoring patients and providing preventive care. Healthcare organizations may also use AI to help ensure care pathway compliance, leaning on technology to suggest the most appropriate next step based on the organization’s pre-existing workflows and care pathways.
Finally, organizations may use AI to track system-wide performance. This may help with identifying potential “gaps” in care — and create additional opportunities to boost patient outcomes and bolster reimbursement.
Driving efficiencies and enhancing talent management
Many healthcare leaders prioritize efficiency, particularly amid the economic headwinds facing healthcare organizations today. Efficiency is especially important for managing complex patient needs. Put simply, complex patient needs often require higher-touch care, and organizations must find strategies to support these patients without ramping up the burden on clinical and non-clinical staff.
AI-driven technologies can play a key role in helping staff work as efficiently as possible by automating tedious processes, including billing, appointment scheduling and aspects of EHR management. They may also support in-demand specialists — for example, with AI tools that help radiologists interpret medical images more quickly and with greater accuracy, or assist pathologists in expediting diagnostic or prognostic reports.
As a result, healthcare organizations may enjoy direct cost savings, as fewer hours are spent on tasks that could be outsourced to or assisted by technology. However, organizations may also realize indirect savings in recruitment and retention costs. These technologies free up time for staff to focus the rewarding work of providing patient care, particularly for high-needs patients, helping to improve the employee experience to reduce turnover.
Investing in AI through an ROI-based lens
AI has the potential to transform several aspects of healthcare, helping to make complex and difficult cases more manageable for staff. But with so many technologies coming to market — and so many problems that healthcare leaders are looking to solve — it may be tempting to get caught up in the hype. Instead, organizations should focus on the financial fundamentals, including short- and long-term ROI, to make financially sound decisions.
That may start with an organization-wide analysis of the pain points currently undermining ROI to identify high-impact opportunities for innovation. An organization facing significant provider burnout and turnover, for example, may benefit most from AI-powered technologies that enhance the customer experience, while an organization with higher-than-average patient attrition may wish to start investing in AI-assisted patient outreach.
As you evaluate solutions, consider time-to-value and how that may impact short- and long-term ROI. In some cases, it might make sense to sacrifice some customization in favor of a turnkey solution that you can deploy quickly; In others, it may be worth the wait to roll out a highly customized solution that would maximize ROI over the long term.
With ROI as your compass, you can help set your organization up for success
Investing in AI can have several financial implications for companies, including a temporary negative impact on cash flow. A financial advisor with expertise in healthcare can help you make the right decision for your organization.
Our team of healthcare banking experts are here to help. With support for cash flow management, assistance in financial planning, and a range of financing products designed with the needs of healthcare in mind, our team can help you craft your plan for innovation — and support you as you navigate the era of AI.
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