A growing number of healthcare organizations are often turning to Generative AI (GenAI) to help them provide better experiences for members, patients and providers, while also achieving higher productivity and lower administrative costs.
Today, healthcare companies’ metrics can revolve around improving individual tasks, focusing on a narrow set of capabilities, organizing IT priorities and measuring time saved. However, with the help of GenAI, organizations are often doing more — or may soon be able to do more — by changing processes and greatly reducing tasks, organizing process transformation, broadening capabilities and focusing on key metrics, such as time to market.
There are applications across the overall care delivery value chain. They often start with documentation, but can also interact with producing or interrogating documents.
GenAI also can become a key component of business model reinvention by enabling the following:
- Increasing qualitative care delivery by using GenAI to help enhance support for patients, physicians, payers and other key stakeholders
- Streamlining the care operating model by internally structuring and responsibly using GenAI technology throughout the company
- Accelerating the delivery model by meeting production requirements for processes, decisions, capabilities, incentives and effective development structures
- Reducing cost of care by offering new ways to help address the challenge of healthcare affordability and cost control
- Amplifying employee engagement by enabling employees to focus on higher value-added activities that can serve patients and members
- Implementing context-aware workflow execution that can reengineer workflows, manage change, and recognize what GenAI can and can’t do
PwC is already working with clients on GenAI use cases that are a starting point for business model reinvention. In fact, payers and providers are currently leveraging GenAI across different areas of the value chain. These include:
- Supporting customer service representatives through GenAI-powered assistants that can provide sentiment analysis, question prompts, Q&A chatbots and automated documentation logging
- Supporting utilization management resources through GenAI-powered assistants that can provide summarization, policy analysis and letter generation
- Using GenAI to help conduct health risk assessments and member information retrieval
- Using natural language processing to help generate data queries (SQL queries) for backend IT functions
- Summarizing policies, vendor contracts and state hearing content for streamlined regulatory compliance functions
On the patient services side, GenAI can be used to help reduce the documentation burden, which can improve the productivity of the clinical staff. In addition, this technology can be used in the back office to help automate revenue processes. It’s important to acknowledge that GenAI is a human-led process, so life-impacting decisions such as diagnoses and treatments should be closely evaluated and monitored by medical professionals. However, GenAI can provide these professionals with time and valuable information to help them evaluate relevant information that make them feel confident with their critical healthcare decisions.