How AI Solutions Aid Medical Facilities in Enhancing Operations and Providing Better Care

AI is a crucial tool for healthcare providers today, from revenue cycle management and patient engagement to operational efficiencies for existing workflows.

FREMONT, CA: The move from a service- and fee-based paradigm to an outcome- and value-based approach, as well as a staffing shortage and cost pressures, are all issues that the healthcare sector is currently dealing with. Hospitals are growing more dispersed, and telehealth and home healthcare are expanding. Patients now expect upfront visibility and price transparency due to the development of high-deductible plans that have converted them into consumers.

But new healthcare AI solutions are assisting healthcare providers in filling those gaps and modernising the way healthcare is provided. The industry has been considering AI from an operational perspective for some time. Companies are now more successful at creating and improving models, which is vital as more data becomes available, and interest is growing as a result. Following are some ways AI has met the challenges on both the operational and consumerisation side of the healthcare delivery system.

NLP Offering Relief for Staffing Issues and Increasing Patient Engagement

Conversational AI and natural language processing (NPL) are now smart enough to be used as the initial point of patient interaction on the front lines. The introduction of voice and chatbots on patient phone lines, clinic applications, and websites is easing some of the workloads for personnel. The technology has resulted in a 21 per cent decrease in the average handle time at healthcare businesses. Additionally, containment rates, which indicate whether a call can be handled by a bot or has to be forwarded to a person, have reached as high as 60 per cent.

Improving Billing and Coding Efficiency

AI and robotic process automation (RPA) are providing enormous benefits in a variety of areas, including establishing codes, forecasting claims, and speeding up the processing of denials. Up to ten per cent of claims are rejected upon initial submission, and of those, 65 per cent are never redone. This may be because it costs USD 31.50 to fix a claim and resubmit it. Before a claim is submitted, AI models may estimate the likelihood of denial, and businesses have cut errors in claims by up to 50 per cent, increasing the likelihood that an appeal will be successful.

Reducing Case Manager Burdens

The administrative labour that goes on in a healthcare company is quite important. AI and automation were created to tackle the repetitive tasks that need precision and speed. When an AI solution is implemented, they've seen firms reduce the medical necessity review for case managers by 75 per cent.

No of their size, a lot of healthcare organisations have already started integrating AI into their operations, especially when it comes to the administrative burden. Scaling that investment, however, is difficult. Organisations that haven't yet started their AI journey are beginning to witness the advantages and realise it's time to join the fight. Collaboration with vendors and systems integrators is the best place to start.