If adopting an AI plan is a team sport, payers will likely have a significant advantage over providers.
This means that by 2024, 25% of health care payers will have an AI strategy in place, while only 15% of health care providers will have an AI strategy in place.
The findings come from a survey of 150 executives from both sectors. The project was conducted by Bain & Company and KLAS Research. Bain released its analysis of the survey results on Sept. 17. Other key findings from the report include:
Seventy-five percent of providers and payers said they increased their IT spending in the past year, a trend that’s likely to continue, the report’s authors predict. 70% of respondents were directly affected by the cyberattack on Change Healthcare and are increasing their spending on cybersecurity.While a 15% adoption rate of the strategy among provider respondents may seem conservative, it represents a 10% increase from the 5% of providers recorded in last year’s survey.
The authors make several useful observations, including the following five:
1. Post-pandemic, healthcare providers and payers will be more inclined to experiment with technology.
“Consistent with survey findings from past years, healthcare providers and payers are prioritizing technology. In a survey of 150 U.S. healthcare providers and payers, nearly 75% of respondents said they had increased their IT investments in the past year,” the authors comment. “We expect this trend to continue.” Read more:
“Healthcare provider organizations are focused on digital transformation to optimize operations and reduce physician burden. Payer IT initiatives are aimed at improving payments through risk adjustment and quality programs, and lowering medical loss rates by optimizing payment integrity.”
2. Both healthcare providers and payers are looking at AI-supported solutions to enhance decision-making, improve operational efficiency, and deliver care and engagement.
Providers have made great strides over the past year, as evidenced by the growth of AI strategies in this area from 5% to 15% from 2023 to 2024.
“When factoring in organization size, payers are roughly on an equal footing when it comes to defining their AI strategy, and the majority of both types of organizations are optimistic about implementing generative AI.”
3. Both healthcare providers and payers are optimistic about implementing generative AI.
The authors note that healthcare providers have begun piloting generative AI in clinical applications such as clinical documentation and decision support tools. Pilots on ambient clinical documentation have “been particularly successful in reducing administrative burden for clinicians and improving the patient experience,” the authors add.
“Insurers are citing contact centre and member chatbot support as the first generative AI use case to gain traction. These deployments aim to reduce the impact of workforce pressures in contact centres, helping to upskill staff and provide more tailored and empathetic communications to members.”
4. Certain barriers still hinder widespread adoption of generative AI by both payers and healthcare providers.
Analysts say both healthcare providers and payers cite regulatory and legal considerations, cost, and deficiencies in accuracy, such as AI illusions, as the main obstacles to implementation.
“Furthermore, there is an increasing need for robust governance frameworks, transparency and accountability mechanisms to ensure the responsible and ethical use of AI in healthcare.”
5. Growing cybersecurity concerns and threats are expected to influence investment choices and vendor selection.
In the wake of the Change Healthcare cybersecurity incident, organizations are hardening their IT infrastructure against threats, the authors report.
“Optimizing clinical workflow remains a top priority as healthcare providers look to streamline processes, reduce administrative burden and improve utilization of labor, capital equipment and facilities. Patient flow solutions stand out in this category.”
“AI tools have great potential to improve outcomes across four quadrants of healthcare’s four goals: improving patient experience, improving population health, reducing costs, and improving provider experience,” Bain and KLAS conclude. “Over the next few years, AI looks set to deliver value in each of these areas, but the journey will be gradual.”
read more.
