The soaring prevalence of artificial intelligence (AI) is reshaping how healthcare organizations operate. ChatGPT, for example, is one of the latest AI trends being used in healthcare clinical services, finance and operations and is even impacting how payors and providers approach their business strategies. AI has become a vital tool for streamlining processes, reducing manual tasks for medical professionals and enhancing patient care.
Some healthcare leaders have concerns that AI is too futuristic for their organizations, could become a substitute for the human element to patient care, or is simply not within budget. Contrary to these beliefs, AI has practical applications that are often cost-effective in the long run.
To leverage AI for meaningful change, healthcare leaders should start by identifying process improvement opportunities. This involves internally pinpointing specific needs, inefficiencies, bottlenecks or quality improvement opportunities where AI can make a valuable impact. Alternatively, you can engage an outside resource to evaluate your people, processes and technology to identify areas where AI can be effectively utilized.
Once you understand your needs and process inefficiencies, you can harness the power of AI to help fill your organization’s specific gaps and ultimately drive better patient outcomes.
This article provides actionable ways to leverage AI in healthcare for better clinical and financial outcomes — and for a strategic technology transformation that's necessary for long-term sustainability.
Healthcare organizations face several major challenges when it comes to financial reporting. Complex reimbursement coding and filing requirements, varying rules, diverse requirements and reimbursement rates from different payors and forecasting complexities can make accurately tracking and reporting revenue a cumbersome task.
Reporting is further complicated when disparate systems are used for billing, finance and patient care. This lack of interoperability makes the process of aggregating and analyzing data for timely, accurate and comprehensive reports difficult and time-consuming, not to mention error-prone. And because many organizations must use their workforce to manually consolidate these reports, it also takes valuable time and resources away from more strategic, industry-focused tasks.
To address these challenges, you can use AI to streamline financial reporting processes, automate data analyses and improve accuracy. Robotic process automation (RPA) tools, for example, can automate tasks related to billing and coding, such as data entry, claims processing and invoice generation. This in turn reduces the risk of human error and improves the accuracy of your financial reports.
AI can also be used to automate the extraction and consolidation of data from various sources, such as electronic health records, billing systems and financial software. AI can continuously monitor financial systems and collect real-time data insights, making it easy for you to generate thorough, dynamic reports on demand. And if your organization must report out to a board, having this meaningful data at your fingertips and being able to report it out quickly allows you to improve transparency with stakeholders, make proactive, better-informed decisions — and be confident about the integrity of your data insights.
Healthcare organizations are no stranger to cost challenges, decreasing resources and the continuous need to do more with less. On the operational side alone, expenses like labor, medical supplies and equipment can put a major strain on financial resources.
While it might seem like AI would only further strain an exhausted budget, it can actually create cost-saving opportunities when used to analyze large datasets, optimize resource allocation and identify waste, process bottlenecks and/or inefficiencies.
Take inventory, for example. Medical supplies and equipment — including gloves, bandages, syringes and medications — are single-use items that are expensive and have expiration dates. If you’re not managing your inventory correctly, you could be accumulating huge expenses just on product waste.
AI algorithms can monitor product expiration dates and implement procedures for timely use or disposal. AI can even streamline your reordering process by automatically placing purchase orders when your inventory has reached predetermined levels. You can use predictive analytics, a type of AI model, to anticipate the supplies you’ll need and when you’ll need them. Predictive maintenance models that can be run by AI for analyzing the condition of equipment can detect potential issues with medical systems or equipment and prevent problems.
AI can also play a crucial role in analyzing provider performance. You can use AI-driven analysis to gain insights into why certain providers deliver low-quality, high-cost care while others offer high-quality, low-cost care. This analysis can enable your organization to identify areas for cost optimization within your operations and help you allocate resources more efficiently and make informed decisions to enhance your overall performance and improve care outcomes.
Additionally, AI can be leveraged to automate journal entry creation, validation and posting. This can help finance teams save time, reduce errors and save money through better tracking and forecasting.
Staffing constraints are an ongoing challenge — medical professionals face longer hours, fewer resources and higher risk of burnout. As a result, organizations are increasingly relying on AI to optimize their approaches to staffing and resource planning.
For example, AI-powered chatbots can automate the time-consuming process of staff scheduling, and predictive analytics can help determine if there are enough personnel in place to meet patient demand.
Back-office work, too, can be more efficient with the right AI tool. AI can function as a digital coworker, complementing the productivity of human workers by taking on the burden of manual, administrative tasks (like data entry and documentation) and simplifying cross-department communication and decision making. This workload redistribution can enable healthcare professionals to shift their focus to higher-value, strategic initiatives, which in turn can alleviate burnout and increase job satisfaction among staff.
Maintaining regulatory compliance is essential, but it’s also incredibly time- and resource-intensive. Even small compliance errors can result in major penalties. AI can help streamline these processes by helping your organization navigate and automate compliance complexities.
One such complexity is the Medicaid re-enrollment process. With the COVID-19 public health emergency ending, many organizations must re-enroll people on Medicaid into the system, causing concerns around timely re-enrollment and taking patients with no payor source.
AI can automate the enrollment process by querying all payors to check if a patient is enrolled in any coverage. This can help identify eligible individuals and ease the burden on both the organization and the patients. And by avoiding extended periods in accounts receivable for uninsured patients, healthcare organizations can reduce financial strain and the need to write off unpaid bills.
Using AI can also be particularly helpful when managing pricing transparency. Healthcare pricing regulations can be complex and subject to frequent changes. To provide comprehensive pricing transparency and ensure accurate, thorough up-front estimates, it’s imperative to have the right technology in place.
AI algorithms can continuously monitor pricing information, both within your organization and industry-wide, to pinpoint any non-compliance patterns or data discrepancies. These algorithms can also be used to compare your pricing data against regulatory guidelines, ensuring that you adhere to the latest regulations.
AI can also strengthen cybersecurity, support compliance with HIPAA regulations and help detect and prevent fraud, waste and abuse.
Healthcare organizations are increasingly concerned about the detrimental consequences of cybersecurity hacks, which can include financial losses, reputational damage or even potential hospital closures. Healthcare leaders can alleviate some of this stress by leveraging AI capabilities to monitor network traffic, user behaviors and system logs to filter out non-threatening activities, detect system vulnerabilities, identify patterns indicative of cyberattacks and address potential cyber threats before they become problems.
To combat fraud, waste and abuse, AI tools can assess large quantities of data, look for anomalies that may indicate suspicious or fraudulent behavior and sound alerts for suspicious activity.
Proactively safeguarding your organization against cyber threats and fraud risks can help you maintain regulatory compliance, mitigate financial losses, protect sensitive patient information and align with HIPAA requirements.
Effective supply chain management is crucial for healthcare providers to ensure the availability of necessary medical supplies and minimize extraneous costs. But while supply chain disruptions may have lessened since their COVID-19 pandemic peak, healthcare organizations continue to face ongoing supply chain challenges (product recalls, rising costs and weather-related delays, to name a few) that may impact the availability and timely delivery of critical healthcare supplies.
AI tools like demand forecasting, supplier management and real-time tracking can help your organization combat these difficulties. AI algorithms can analyze supplier performance, reliability and financial stability, helping to select and manage suppliers and proactively address any potential disruptions.
Forecasting and tracking can be used to analyze historical data, seasonal patterns and patient demographics to improve demand predictions, and give you real-time visibility into products’ progress as they move throughout the supply chain. AI-powered tools can also analyze routes, pinpoint trouble spots and re-route transportation to avoid weather delays or other bottlenecks.
AI technology has become a powerful tool for driving transformation in healthcare. Though some healthcare leaders may have reservations about AI, it can be a catalyst for optimizing performance, increasing staff productivity and improving resource utilization. By harnessing AI to fill your organization’s process gaps, you could benefit from time and cost efficiencies, ultimately helping you deliver optimal patient care.
Choosing the right AI tools for your healthcare organization can be challenging, especially the first time. Contact our healthcare experts today to learn what AI applications will best suit your staffing, process improvement and cost-savings needs.
