Administrative AI Systems Important in Healthcare

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Robotic surgery enhanced by artificial intelligence (AI) is making big strides in baby steps as this technology must clear all manner of regulatory hurdles before it gets near a patient.

AI-powered back-office solutions, on the other hand, require no special permission and are more vital to the health of the healthcare industry itself in 2022.

The MIT/Sloan Management Review said as much Monday (April 11), noting in an article that while “we’re confident that [AI hasn’t] replaced a single human clinician … [contrast] that situation with the current potential for administrative AI systems in healthcare.”

“These use cases don’t have to be approved by the FDA, or even by insurance companies (indeed, they are used in many cases to reduce friction with payers),” the report stated. “They don’t have to be accepted by physicians, for the most part.”

See also: 76% of Healthcare Firms Willing to Innovate Accounts Receivable for Cost Savings

The trend is clear across the vast healthcare sector, particularly during the pandemic when payments processing took a back seat to the health emergency.

In early April, cloud analytics and payments platform Clarify Health secured $150 million in a Series D fundraising round for what CEO Dr. Jean Drouin called a “mission … to fundamentally improve the way healthcare is paid for and delivered.”

“We finally have the AI-driven intelligence that healthcare organizations need to optimize every patient journey and embrace value-based arrangements across providers, payers and life sciences,” Drouin said.

Fraud, Waste and Abuse in the Crosshairs

According to the study “AI In Focus: The Healthcare Technology Roadmap,” a PYMNTS collaboration with Brighterion, a Mastercard company, momentum is building.

Get the study: AI In Focus: The Healthcare Technology Roadmap

“Trend lines suggest that AI may become a much more significant part of insurers’ technology resources in the near future,” per the study, which found that 71% of insurers that do not currently use AI to detect fraud, waste and abuse (FWA) plan to invest in the technology within the next one to three years.

Among other findings, the study noted: “Approximately 12% of surveyed healthcare payors and insurers are currently using AI for payment-related purposes — a threefold increase from 2019. Close to three-quarters of executives plan to invest in [AI] over the next three years.”

Revenue cycle management (RCM) is another promising application of AI in healthcare.

In an interview, Synchrony Senior Vice President and General Manager of Health Shannon Burke, Systems told PYMNTS: “The RCM leaders have known for a long time that the earlier you collect in the cycle, the better you’re going to get paid.”

See more: Cost Transparency Is Patient Payments Starting Point

In its coverage, MIT/Sloane Management Review called RCM “[f]oremost among the opportunities for administrative AI.”

Pointing to the complexities of estimating care costs, as well as billing and payments, MIT said “patients are more likely to pay medical bills when they have accurate estimates,” giving the example of Baylor Scott & White Health’s system where “70% of its estimates are created without human intervention, and the estimates have led to a 60% to 100% improvement in point-of-service collections.”

Read also: Healthcare Platforms Integrate More Devices, Data as Sector Rushes to Modernize

More large players are bringing AI to bear on administrative work as health systems and practices clear pandemic backlogs and seek more informed care from providers.

In March, General Electric (GE) announced the introduction of its Edison Digital Health Platform, described in a press release as “a vendor-agnostic hosting and data aggregation platform with an integrated artificial intelligence (AI) engine.”

GE Healthcare Chief Digital Officer Amit Phadnis said in the announcement that “Edison Digital Health Platform is being designed to enable healthcare systems to have a single platform on which to host and integrate apps into clinical workflows.”