Leveraging Generative AI for Enhanced Member and Patient Services

Generative AI is an emerging and exciting frontier with the capability to transform healthcare. Combining the realms of healthcare with artificial intelligence, particularly through the lens of GenAI can open the door to new and innovative solutions for care delivery and enhanced operational effectiveness. While the transformative potential of GenAI in healthcare is immense, it’s crucial to navigate its challenges and risks cautiously.  

Designing GenAI with the user at the center is key as well as ensuring that the technology is intuitive and builds a solid foundation of trust. It is also important to harness its capabilities to address ongoing healthcare disparities for a more equitable healthcare landscape. Utilizing this technology to generate insightful, data-driven analytics can significantly enhance decision-making and patient outcomes. 

It is imperative to acknowledge the ethical and regulatory challenges posed by GenAI. This involves ensuring patient privacy, securing data and upholding data ownership rights. 

There is a need to develop standards and policies that ensure its safe and ethical use. While GenAI is a powerful tool, we also have a responsibility to use it wisely. 

Utilize the Potential of Generative AI

How do companies utilize the potential of Generative AI for their organization, while also protecting their members and patients’ data?  

We heard some interesting insights on this from key tech leaders at the ‘New-Now Studio – Design roundtable discussion’ at the Emids Healthcare Summit 2023

With an eye toward innovation, ethics and improved patient outcomes, let’s delve into how GenAI empowers individuals by offering personalized health data for informed decision-making with payers and providers, how it can enhance clinical decisions by utilizing extensive data and streamline administrative tasks to boost efficiency, thereby helping in cost cutting and improved patient care.  

Consumer-Centric Approach

GenAI has redefined healthcare by leveraging data analysis to tailor treatment plans, predict health risks and recommend preventive measures, significantly enhancing patient outcomes. This pivotal shift emphasizes a consumer-centric approach, prominently demonstrated through the implementation of chatbots for customer service. The remarkable transformations driven by consumer-oriented AI solutions are evident as AI-powered customer service dramatically reduces call durations, boosting both efficiency and satisfaction levels.  

Moreover, the integration of virtual health assistants, empowered by GenAI, delivers personalized, real-time support, fundamentally elevating and personalizing the overall member experience in healthcare settings. Training AI models to aggregate data for streamlined customer service is a meticulous approach that emphasizes accuracy and prompt issue resolution, which notably reduces call volumes by 10-15%, resolving queries within an impressive 1-2 minutes. 

Mental Health Care: A Shift Towards AI and Agility 

The COVID-19 pandemic has undeniably served as a catalyst for change in the traditionally resistant mental health space, pushing it towards technological adaptation. One of the primary issues lies in accurately matching patients to the appropriate level of care and centralizing access to referrals. The traditional methods of patient assignment and referral management have proven to be inefficient and often lead to delays in treatment. 

AI can streamline the prior authorization process, effectively saving nurses’ valuable time that can be better spent on patient care. By automating the administrative tasks, healthcare providers can focus more on delivering quality care to their patients. 

AI goes beyond administrative tasks, rapidly comparing documents and uncovering crucial insights. In mental health care, it swiftly analyzes patient records, influencing treatment paths. Its role in document analysis is pivotal, focusing on enhancing user experience through responsive feedback mechanisms. Analyzing patient feedback enables healthcare providers to align services with patient needs and expectations effectively. 

Collaboration and Balancing Human Expertise 

AI is aimed at enhancing patient experiences, complementing rather than replacing human expertise, fostering a collaborative approach for optimal outcomes. Concerns arise about its potential to replace human decision-making and raises a concern of job security.  

Preserving the human element alongside AI advancements remains crucial for balanced, empathetic decision-making in healthcare and it is crucial to actively engage teams using AI to navigate this transition effectively, fostering a sense of trust and understanding that will help in product designing and future planning. 

Revolutionizing Patient and Member Experiences through Human-centered Design 

Human-centered Design prioritizes understanding patients’/members’ needs by directly engaging with them to grasp their challenges and processes. Amidst concerns about optimizing provider services and reducing medical costs, technology teams and CEOs are reminded to understand patient and member needs and use it to inform patient/member experiences. This approach enables the identification of key areas for improvement based on their primary concerns. 

Barriers to implementing GenAI

During the pandemic, behavioural health providers shifted from resisting technology as marginalized individuals struggled to access care. This led to a grassroots initiative, virtually connecting patients with suitable providers, streamlining referrals and care coordination. Tracking metrics such as wait times and satisfaction notably improved care delivery. 

Implementing GenAI faces significant barriers, notably trust and transparency. The challenge is not about imposing technology but ensuring its relevance to real healthcare needs. Uncertainty persists regarding responsibility for patient data understanding and the importance of data quality for effective AI outcomes. Overcoming these barriers require trust-building, genuine problem-solving and data clarity. 

As GenAI takes center stage in healthcare, successful integration requires thoughtful consideration and an emphasis on improved services, teamwork and retaining human skills. 

Special thanks to the participants of the roundtable discussion whose valuable insights and contributions have significantly enriched the content of this article:

  • Terry Goertz, CTO, Hansei Solutions
  • Leah Briggs – Director of Product, CVS Health
  • Milind Shah – Director of Engineering, Elevance Health
  • Shankar Checka – Sr. Director of Technology, Lumeris
  • Kim Corace – VP Transformation, Royal Ottawa Mental Health Center
  • Linda Leigh Brock – VP of Product Management, NASCO
  • Samantha Shahani – Staff VP, CX Member Engagement, Elevance Health
  • Paul Cox – CEO, Magic Medical
  • Gary Garber – Director, Safe Medical Care Research 

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