Health care organizations can use AI to solve practical business problems in transformational ways

By Kumar Chebrolu, managing director, Deloitte Consulting, LLP

Artificial intelligence (AI) is already helping to make some aspects of health care more efficient. As data—including health care and social determinants of health (SDoH)—becomes more interoperable and secure, we expect AI will become a critical engine driving digital transformation and data analytics. For example, with many health systems reeling from the COVID-19 pandemic, AI-enabled solutions could help reduce costs by automating some types of manual work. AI could also be used by health plans to develop new products and improve consumer engagement.

The pandemic overwhelmed many hospitals and health systems and exposed limitations in their ability to deliver care and reduce costs. Since March, many health systems have experienced a significant shift to virtual health, fueled by necessity and regulatory flexibility, according to results of Deloitte's 2020 survey of physicians. The pandemic also opened the aperture for AI and digital technologies to solve problems.

Our latest report, Smart use of artificial intelligence in health care, offers a thorough look at how health care organizations are using AI. We determined that health care organizations can scale up their AI investment by pairing it with a robust security and a data-governance strategy.

AI is a key component in the future of health

AI is already being used to automate processes in health care. In our vision of the future of health, we view radically interoperable data as central to the promise of more consumer-focused, prevention-oriented care. Data analytics will be critical for generating actionable insight from the vast data that will be generated by ubiquitous sources. AI is already embedded into data analytics and is likely to become even more so in the future.

AI uses algorithms and machine learning (ML) to analyze and provide insights based on data. It also can be used to automate some types of repetitive work and has the potential to augment decision-making among operational and clinical staff. By reducing the time spent on administrative tasks, humans can focus on more challenging, interesting, and impactful management and clinical work.

Today, health care organizations often experience pervasive problems across their value chains, which can span every process along the continuum. In the future, health care organizations that apply AI across every process—from care to cure—will likely be able to improve the health and well-being of consumers.

Five areas AI could improve 

Many day-to-day, non-clinical operations (e.g., submitting and paying claims) are ripe for AI. For example, natural language processing can understand unstructured data from electronic health records. AI can automate tedious administrative work and generate insights for monitoring fraud and abuse or physician practice patterns. Here are five areas where we see AI having the biggest impact in health care:

1. Improving patient care: AI-based solutions can effectively streamline diagnostics and suggest personalized treatment options by tapping into vast amounts of structured and unstructured medical data across institutions. Real-time, data-driven insights can help clinicians and care teams make more-informed decisions, which can be altered and implemented based on their personal expertise.
2. Simplifying administrative processes: Operational issues (e.g., number of staff, staff availability, skills, and specific equipment required) have been a major challenge for many health systems since the onset of the pandemic. AI-powered solutions can assist in accurately scheduling and planning clinical staff rotation.
3. Catching errors and reducing burnout: AI can help minimize patient risk by identifying medication errors, which traditional rule-based clinical-decision support systems might miss. For example, an algorithm might determine the dosage for a written prescription is incorrect and send an alert to the physician’s system. At the same time, another algorithm could prioritize the alerts that the physician sees and remove those that don’t require confirmation or intervention. This can help reduce alert fatigue.
4. Increasing efficiency and improving the patient experience: The ability to quickly examine large amounts of information can help hospital and health plan administrators optimize performance, increase productivity, and improve resource utilization, resulting in time and cost efficiencies. Additionally, AI-enabled solutions can speed up and strengthen the insight-generation process by allowing the organization to gain the holistic picture it needs to make data-driven decisions. AI can also deliver personalized experiences by facilitating conversations with patients through virtual assistants.
5. Identifying fraud, waste, and abuse (FWA): AI-based analytics can help health plans detect and reduce improper billing practices, which can streamline reimbursement. Additionally, pharmacy benefit managers (PBMs) can use AI to detect potential problems with prescription claims data, reduce improper claims payment, and minimize the manual effort often required to review claims. AI can also help to effectively and proactively identify potential fraud and abuse.