When I was at the Business School in 2016, I wrote a composition about blockchain and its implications in medical care. At that time, all experts proclaimed with confidence that this new technology would “revolutionize” medical care. I remember thinking about that moment that I really did not understand. The systemic problems that exist in medical care, with misaligned economic incentives that drive the behavior of the system that rewards the disease instead of well -being, would be approached remotely by blockchain technology. Absolutely, Blockchain helps guarantee the privacy of data, but that is a specific solution, not a comprehensive solution solution that we need to really revolutionize medical care.
The current dialog on generative (Genai) hits me in a similar vein. Yes, I think Genai can enable solutions that will significantly affect health workflows. An example is through the automation of repetitive low risk tasks, such as those associated with administrative responsibilities. Imagine worldly administrative tasks managed by AI, with atypical values based on exception driven to human users. Automate these free workflows to doctors to focus on their patients and provide better care.
For this technology to take even more in 2025, the Genai in medical care needs to change potential to a practical value, focusing on delivering concrete benefits for doctors and patients. Health systems will develop solid government systems for evaluation, purchase, implementation and continuous monitoring of Genai solutions, and will require a tangible ROI for any solution. This transition from the exaggeration cycle to the value cycle will focus on quantifying Genai’s benefits. An example would be to measure reduced administrative burns, such as time savings and a reduced exhaustion of doctors who use tools such as environmental scribes.
However, to really “revolutionize” medical care, we must address the underlying need of those permanent administrative tasks that are fundamental requirements and that do not add value and represent spent dollars that do not have an impact on high quality patient care. According to a recent study in Jama Network, so that a primary care provider receives $ 100 in the payment of patient services, they must spend $ 20.49 on administrative costs. These administrative costs represent a 20% tax on patient care that provides zero value towards better medical care results.
Could Genai help standardize administrative costs? Prior authorization tasks are already being addressed by Genai, but the variability in the payer requirements for prior authorization clinical data and medical need requirements limit their effectiveness. What would happen if prior authorization data and medical need requirements were standardized in all state, federal and commercial payers? Genai could also analyze the multiple of paying contracts in the power of health, all of which vary dramatically between the different business lines of state, commercial and federal payers, to find the community and standardize pearls. Finally, imagine Genai as a tool to enable a unique transactional model that allows health systems to transact payments uniformly for state, federal and commercial payers.
In spite of what some may claim, AI will never replace doctors, but we could use AI to help improve the general scaffolding that the reimbursement of medical care is done, decreasing costs and releasing the expense to approaches directly linked to patients.
Paleing Genai to address administrative tasks, which incurs their own expenses, can improve workflows, but wonders the fundamental and systemic problems that face medical care. Yes, we need a revolution in medical care. However, it must obtain the standardization of data exchange, simplified and simplified payment methodologies, and the comprehensive medical care policy to regulate the entire subove. Requesting human effort and yet can be enabled by Genai.
Photo: Damon_moss, Getty Images
Holly Urban, MD, MBA has extensive experience in health technology and believes in the power of evidence based on EHRs beyond transactional systems into tools that allow doctors to provide better patient results. After practicing as a primary care pediatrician, Dr. Urban worked for several technology -based content and evidence of EHR, and has served in medical care leadership roles for about fifteen years. Before joining Wolters Kluwer Health, she served as CMIO in Oracle Cerner, Director of Product Management of MCG Health and Vice President of Product Management at McKesson Horizon Clinicals.
This publication appears through Medical influencers program. Anyone can publish their perspective on business and innovation in medical care in Medcity News through influential people of Medcy. Click here to find out how.