Artificial intelligence was a key theme in a session on how digital tools are changing the payer industry at this year's Fierce Health Payer Summit.
The panel took place last Thursday at the annual event and was moderated by Staff Writer Emma Beavins. The panelists spoke about the importance of improving payer-provider relationships and the member experience through AI and data-sharing.
Consumers are used to the convenience offered by platforms like Netflix and Amazon, yet healthcare is lagging. AI can help streamline the member experience, including by surfacing transparent pricing. Doing so carries a high return on investment, Brittany Poche, director of solutions at revenue cycle management company Norwood, said. “Having that whole transparency and that experience, that is going to really move us,” Poche said on the panel.
Interoperability also remains a longstanding priority. “The future is sharing that data more seamlessly, sharing insights from that data—how can we take action on this,” Poche added. “Strengthening that payer and provider relationship by sharing the data both ways is important.”
When it comes to point solution fatigue, the “fragmentation hurdle” is one that plagues every healthcare stakeholder, said Meg Barron, managing director of engagement and outreach at the nonprofit Peterson Health Technology Institute (PHTI). The organization produces reports on a wide range of specialty areas, from hypertension to MSK to mental health, aiming to surface what solutions are most valuable and “cut through the clutter a little bit.”
An upcoming PHTI report to be published in January will feature template contracts to support performance-based arrangements between tech vendors and payers, per Barron. Today, existing contracts may be set up to disproportionately benefit tech vendors, Barron noted.
Potential vendor partners should be aligned with what the payer wants to accomplish and what their desired process is, said Cassie Houff, vice president of post-acute care solutions at provider OneHome. A good vendor should support a payer’s change management—crucial to deploying new tools—and keep up with the latest regulations “so that you can feel comfortable that your clinicians or your team is going to be part of the development.”
Today, AI use cases typically focus on correcting provider inefficiencies. Future opportunities, in Houff’s view, include creating better connectivity across levels of care and leveraging AI in care delivery itself. There’s a lot of fear about using AI in healthcare, she acknowledged. Keeping a human in the loop is one way to build trust with such solutions.
“Digital tools are there to enhance what our clinicians are there to do,” Houff said. “That speeds up the ability for patients to get to the right level of care when they need it, and it enables our clinicians to stay engaged.”
“AI as your invisible partner,” echoed Lori Howard, founder and managing partner at consultancy Greenfield Health Solutions. “It’s not supposed to take your job, it’s supposed to be your invisible partner in the background.”
Payers are ultimately liable for the work vendors do. Good partners should be prepared to share the code and documentation for how an algorithm or tool was vetted. This might include making sure there is no bias, there are no interruptions to care and how data are being used or stored. Payers must vet vendors carefully to ensure they are consistent with their own guiding principles, Howard said.
“Whatever they do for you, it is you,” Howard said. “The government doesn’t really care what the name of the company is.”