Early data and use cases suggest that artificial intelligence (AI) powered tools can drive improvements and efficiencies in health care quality, population health analytics and access to care.
The promise of AI in health care has largely been discussed through the lens of enhancing the patient experience, reducing provider burnout and optimizing the pharmaceutical research and development process. These present tremendous opportunities for AI within each area.
One area of opportunity that has been overlooked to date is the way AI can drive improvements in employer-sponsored health care. Given that approximately half of Americans (160 million people) receive their health coverage from an employer, leveraging AI in a thoughtful and targeted way within this sector could drive significant improvements.
Five key areas include:
Improve patient navigation
AI can help patients navigate complex health care systems by matching medical history with the right care and available benefits. Challenges include data fragmentation and the need for improved data infrastructure.
Identify and mitigate bias and risks
AI can provide actionable insights into future health needs, aiding in disease management and prevention. At the same time, addressing systemic bias and ensuring accurate data representation are critical for effective risk prediction.
Improve billing and administrative efficiency
AI can automate billing and coding, reducing errors and administrative burdens. This has the potential to deliver real-time transparency in cost and coverage status, which can reduce current friction points between patients and health plans.
Optimize provider time
AI tools can create efficiencies in administrative tasks, reducing burnout and allowing providers to focus more on patient care.
Clinical decision support
AI can assist in medical imaging and treatment planning, improving decision-making speed and accuracy.
Challenges and considerations
- The need for standardized frameworks and regulations to ensure ethical AI use.
- Balancing innovation with data privacy and security.
- The role of third-party vendors and health systems in developing AI tools.
- Addressing regulatory concerns, particularly regarding generative AI tools.
The pace at which AI-driven solutions are being developed is exciting and offers a lot of potential to improve health care for employers, patients and providers. 2025 will be a critical year for the application of AI in health care, and we must continue to ensure the right foundation is in place.
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