The adoption of generative AI in the U.S. healthcare ecosystem has only just begun. Both healthcare payers and providers remain cautious about how to use this latest version of artificial intelligence, and rightfully so. You have to balance the potential benefits of generative AI with significant, important operational issues, such as ensuring patient data privacy and complying with regulatory requirements.
And yet, generative AI is a transformative technology—one that cannot be ignored. Doing so will quickly put your organization at a significant disadvantage. Generative AI could be the deciding factor in the quest to deliver patient-centric care, enabling personalized treatment, improving communications, and ultimately empowering your patients or members.
Digital solutions based on generative AI will soon become commonplace in all aspects of healthcare delivery and operations. Any and all activities that focus on improving patient data, processes and communications are prime for improvement. Here’s how generative AI could be used to create patient-centric care:
Improve patient care with next best action. With generative AI-based analytics and large language models, healthcare professionals will have a greater capacity to make tailored recommendations for preventative screenings and services.
Enhance the customer experience for the patient or plan member. Implementing generative AI within a contact center can greatly improve the customer experience by making interactions quicker and more efficient. All parties will be able to securely access appropriate and relevant information in their preferred manner in an AI-driven omnichannel environment.
Complete the pre-authorization process quicker. Today, the pre-authorization process is a cumbersome exchange of information between provider and plan that often delays patient care. Generative AI will be used to produce clinical summaries, enabling faster more effective clinical reviews, and subsequent approvals to ensure patients get access to needed care promptly.
Capture patient documentation with a digital scribe. Physicians will turn to a digital scribe to better capture patient-provider interactions. This new technology will allow healthcare providers to focus more on patient care and less on paperwork. Further, an AI-based digital scribe could uncover patient insights, leading to better care.
Digital solutions to implement generative AI in healthcare
EXL, a leading data analytics and digital solutions company, has developed an AI platform that combines foundational generative AI models with our expertise in data engineering, AI solutions, and proprietary data sets. Our digital solutions improve productivity, unlock new insights, and create hyper-personalized customer experiences.
EXL has more than 50 AI-based accelerators deployed in the marketplace. These include our core solutions EXELIA.AI™ an AI-based tool that delivers human-like customer engagement to improve call center operations; and XTRAKTO.AI™, an AI-powered intelligent document processing solution for back-office operations that uses machine learning, natural language processing, and computer vision.
Specifically for healthcare payers and providers, EXL has developed AI-based solutions for clinical operations to transform end-to-end patient or member management. This includes digital tools to automate the intake process, clinical summarization, and supported decision-making solutions, and a complete set of AI-based audits and controls to ensure operational efficiency.
How to get started with generative AI in healthcare
Ever since generative AI exploded into the market, EXL has been working with clients across industries to scale enterprise-wide initiatives. Our EXL Health team is no exception. Utilizing our deep domain expertise, we are working with healthcare payers and providers to map processes and identify points of friction and opportunities for improvement by using generative AI technology.
We offer these recommendations for how your organization can get started in implementing a generative AI solution. Knowing that data security is paramount, begin with a small project in a secure, closed environment. Create a test case by deploying a generative AI solution on a back-office process that is non-patient or non-member facing.
Focus on an administrative operation that is expensive, currently relies on heavy manual activity, and is hindered by a large amount of unstructured data. One example is creating an AI-based digital agent to assist with annual membership and enrollment for health plans. Other options include using generative AI to support clinical summarization work, referral management, or to optimize your supply chain. To build effective and scalable AI solutions establish a data strategy, data governance, data engineering, and a cloud infrastructure built on your organization’s vision, goals, and roadmap
To learn more about EXL Health and how we can drive your data-led transformation, watch this video. And for AI solutions in healthcare, see how it can integrate into digital case management. Learn more about how EXL can put generative AI to work for your business here.
About the Authors:
Anita Mahon is executive vice president and global head of Healthcare business unit at EXL, a multinational data analytics and digital operations and solutions company. Dave Jackson is vice president and head of Healthcare consulting at EXL.
