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Report: Generative AI and Integration Key to Bridging Payer-Provider Gap

by Fred Pennic 03/28/2024 Leave a Comment

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Report: Generative AI and Integration Key to Bridging Payer-Provider Gap, Boosting Healthcare

What You Should Know:

– A new report by HFS Research, in collaboration with Cognizant, sheds light on critical trends shaping the future of healthcare in the United States. The report, titled “Re-energize Health Consumer Engagement and Bridge the Payer-Provider Divide with GenAI,” explores the potential of Generative Artificial Intelligence (GenAI) and vertical integration to improve healthcare delivery.

– The report also emphasizes that the healthcare system must embrace new approaches and technologies like GenAI to address current challenges and create a future with improved health outcomes and a more engaged patient population.

Key Findings and Challenges

The report surveyed C-suite executives and senior leaders from 350 US health plans and health systems. Key findings include:

  • Disconnects Between Payers and Providers: A significant gap exists between health plans (payers) and health systems (providers) in understanding member/patient needs. While 50% of health plans believe they possess the digital tools to meet these needs, only 40% claim to truly understand them. This disconnect can negatively impact patient engagement and health outcomes.
  • Deteriorating Health Outcomes: The US healthcare system faces declining life expectancy, rising chronic conditions, and mental health epidemics. These factors necessitate a focus on the “triple aim” of healthcare: reducing costs, enhancing patient experience, and improving health outcomes.
  • GenAI’s Potential: 25% of providers plan to leverage GenAI for patient engagement, including personalization in acute care settings, customized recovery and wellness content, and generating medical summaries. However, a lack of talent with skills in programming, data science, and domain expertise remains a hurdle to widespread adoption.
  • Leadership Ambivalence: While healthcare leadership expresses interest in GenAI, concerns exist about its actual impact.

6 Actionable Opportunities for Health Systems

The report highlights six actionable opportunities for the healthcare system:

  1. Embrace GenAI as a Strategic Asset: GenAI can be a valuable tool for driving value from investments in areas like vertical integration.
  2. Bridge the Payer-Provider Divide: Collaboration and improved communication are crucial for a more patient-centric healthcare system.
  3. Invest in Digital Transformation: Modernizing technology and processes is essential for meeting evolving consumer needs.
  4. Develop a GenAI Adoption Strategy: Healthcare organizations need a clear roadmap for integrating GenAI while addressing talent gaps.
  5. Focus on the Triple Aim: Prioritize initiatives that address cost reduction, improve patient experience, and achieve better health outcomes.
  6. Leverage New Care Models: Explore innovative care delivery models, such as the resurgence of digitally-driven primary care.

“The report highlights the disconnect between payers and providers and its impact on patient engagement and health outcomes,” said Patricia Birch SVP and Chief Strategy Officer for Cognizant Health Sciences and report co-author. “We believe this research will encourage healthcare stakeholders to embrace gen AI as a strategic asset for driving value from high priority investments, including vertical integration.”

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Tagged With: Artificial Intelligence, Generative AI

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