Revenue Cycle Insider

Balancing top-notch patient care while managing care costs has been a struggle.

An important method for trying to control costs has been to attempt to accurately predict the needs of the patient. It is challenging at best to precisely determine those needs and equally difficult to estimate their associated cost.

Accurate forecasting of likely costs can help with planning and allocation of resources. Many believe the solution to accomplish this is artificial intelligence (AI) systems.

Understand the Benefits of AI

Increasingly, AI and related technologies are being used to help forecast patient needs in order to meet those needs more effectively, and provide cost-reducing solutions.

Result: AI can not only help to predict the cost of care, but it can also help healthcare providers and patients plan. Experts have found AI can better allocate scarce resources and reduce time, which provides for a considerably more efficient and cost-effective process and improves patient satisfaction and clinical outcomes.

The Association of Financial Professionals (AFP) agrees. The AFP wrote: “Hospitals and healthcare providers use AI to predict patient admission rates and optimize resource allocation. AI models can help — adjust staffing levels, manage bed availability, etc., by considering factors like historical patient data, seasonality and disease outbreaks,” in an online analysis.

Reality: Use of AI in the healthcare setting is growing. To successfully implement these technologies, it is important that healthcare organizations become familiar with the types of AI and how to use these tools.

Recognize the AI Types

The National Artificial Intelligence Act of 2020 defines the term ‘artificial intelligence’ as “a machine-based system that can, for a given set of human-defined objectives, make predictions, recommendations or decisions influencing real or virtual environments.”

Problem: The term itself describes a wide range of technologies that don’t always have a standard definition. Simplilearn lists and defines the various AI types to know about in 2024:

Capabilities-based AI includes:

• Narrow AI (Weak AI): Designed to perform a narrow task (e.g., facial recognition, internet searches, or driving a car). The technology operates under a limited predefined range or set of contexts.
• General AI (Strong AI): Endowed with broad human-like cognitive capabilities, enabling it to tackle new and unfamiliar tasks autonomously. This framework possesses the capacity to discern, assimilate, and utilize its intelligence to resolve any challenge without needing human guidance.
• Superintelligent AI: A future form of AI where machines could surpass human intelligence. This form is speculative and not yet realized.

Functionalities-based AI includes:

• Reactive machines: Do not store memories or past experiences for future actions. They analyze and respond to different situations.
• Limited memory: Can make informed and improved decisions by studying the past data it has collected. Most present-day AI applications, from chatbots and virtual assistants to self-driving cars, fall into this category.
• Theory of mind: A more advanced type that researchers are still working on. It would entail understanding and remembering emotions, beliefs, needs, and depending on those, making decisions. This type requires the machine to truly understand humans.
• Self-aware AI: A future AI where machines will have their own consciousness, sentience, and self-awareness. This type of AI is still theoretical and would be capable of understanding and possessing emotions, which could lead them to form beliefs and desires.

Know Where AI Is Working

Paragon Health Institute concludes there are three main ways AI may reduce medical costs:

• Productivity gains
• Quality improvements
• Autonomous care

Productivity gains: In July 2024, Paragon published a research paper where it identifies administrative tasks as a key area for productivity gains.

Examples: Repetitive or time‑consuming tasks being automated include:

• Patient communication (virtual assistants and AI-powered chatbots), which reduce time spent on calls and answering emails;
• Prior authorization systems that can expedite the substantial data entry requirements; and
• Clinical documentation like capturing of clinical notes, production of referral letters, generation of after visit summaries, and population of the electronic health record (EHR) and patient aftercare monitoring activities.

Another advantage: Paragon also advises that AI systems can automate back-office claims processing and denial management to streamline processes, reduce paperwork, and improve productivity and efficiency.

Quality improvements: Quality improvements come in the form of AI-improved patient diagnostics. It has been found that AI can, in some instances, be more accurate than human beings.

Example: In a December 2023 White House Executive Blog post, the White House recognized AI’s advantage in analyzing images more quickly and effectively for breast cancer, lung nodules, and other conditions.

Today: Experts embrace AI’s benefits for:

• Assisting clinicians with image preparation and evaluation,
• Diagnosis of and planning tasks for certain cancers,
• Surgical procedure guidance,
• Post-diagnosis and treatment health management,
• Improvements to clinical trial design, and
• Optimization of new drug manufacturing.

Autonomous care: Autonomous care systems are technologies capable of providing medical services with little or no human supervision. Numerous studies and articles can be found that shows AI is being used throughout the continuum of care including purposes outside of the office or healthcare facility.

Examples: Smartphone medical apps, intelligent symptom checkers, health management apps, and virtual medical assistants that diagnose illness and provide the user with feedback.

Advantage: Many apps help people manage their health themselves, which can have a direct impact on healthcare costs. In a recent Mayo Clinic Healthy Aging article, the editors advised AI can help people better manage chronic illnesses, such as asthma, diabetes, and high blood pressure.

The contributors added that these systems can also help disseminate information on disease prevention and empower the public to make more informed choices.

Explore AI’s Role in Healthcare

AI in healthcare has many cost-saving benefits, including:

• The technology can be an effective tool to help manage and reduce costs through streamlining of administrative activities and workflow
• Improving patient care through better diagnostics and more precise treatment
• Providing for future advancements in automation and research and development

Additionally, the Health AI Partnership (HAIP) is a multi-stakeholder collaborative that focuses on helping healthcare organizations evaluate and implement AI, and provides resources and guidance for using AI and related emerging technologies. So, if you have not dipped your toe in to the world of AI you may want to check them out before taking the plunge.

Patricia Zubritzky, BS, CRCE-I, Contributing Writer, Pittsburgh, Pa.