Potential uses of generative AI in healthcare
Generative artificial intelligence is artificial intelligence capable of generating text, images or other data using generative models, often in response to prompts. Generative AI models learn the patterns and structure of their input training data and then generate new data that has similar characteristics.
Private payers:
Healthcare management: synthesize clinical notes for care managers; synthesize medical and referral information; generate care plans and summaries for members
Member services: create custom coverage summaries for specific benefits questions (online and via call-center contacts); generate call scripts and other content for outbound nonclinical communications; deploy adaptive chatbots and smart routing to help answer service questions for members and providers; suggest clinicians based on parameters (for example, coverage, location, preferences, conditions)
Provider relationship management: compare plan/product features and networks; generate standard communications (for example, welcome letters, reports, new-member needs, claim denials); summarize gaps in provider directories (for example, update open panel); generate reports and observations for providers and vendors on performance and gap closures
Corporate functions: generate HR self-serve functions (for example, first-line interactions/responses, onboarding videos); synthesize requests for proposals (RFPs) and generate responses; draft vendor communications; automate accounting by extracting relevant numbers; generate reports in standard format; internally summarize updated risk/legal processes as regulation changes; provide large-scale coverage updates for policyholders as regulations change; expedite redetermination processes with enhanced recurring eligibility screening summaries; generate reports and KPIs across functions
Claims management: generate summaries of manual and denied claims issues and sources to determine solutions; aggregate information for complex claims to reduce processing time; autogenerate summaries and outcomes for prior authorization requests; draft responses to appeals and grievances inquiries
Marketing and sales: analyze consumer distribution to develop personalized plans/products; analyze customer feedback by summarizing and extracting themes from online text/images; improve sales support/chatbots to help potential members understand coverage options and choose plans accordingly; create “first draft” materials and product overviews for brokers by product and line of business (LOB), employers, and Affordable Care Act and Medicare Advantage members (within guidelines and needed reviews)
Hospitals and physician groups:
Continuity of care: summarize discharge information and follow-up needs for post-acute care; generate care summaries for referrals; synthesize specialist notes for primary-care physician team
Quality and safety: synthesize and recommend tailored risk considerations for patients based on their medical history and existing medical literature
Value-based care: improve documentation accuracy and leverage structured and unstructured data to create patient education videos, images, and summaries; draft standard value-based care and carve out contracts based on market characteristics
Network and market insights: autogenerate provider segmentation summaries by specialty; summarize market performance and comparisons based on external resources and data
Reimbursement: develop prior authorization documentation for payers; generate a list of current conditions and potential codes based on voice, electronic medical records (EMRs), text, and other data; create care management summaries identifying coding errors across claims; automate coding and checks based on physician notes
Clinical operations: generate post-visit summaries and instructions; generate and synthesize care coordination notes, changes in EMRs, dictations, and messages; generate workflow materials and schedules for processes and locations; create educational materials on disease identification and management; develop personalized training journeys for clinicians across types and synthesize requirements of programs
Corporate functions: IT (develop code, assist cybersecurity test-case generation and quality assurance); procurement (draft RFPs, contracts, generate reports and KPIs, draft vendor communications, create purchase orders based on supply levels); talent (assist hiring, generate offer letters and packets, create customized standard operating procedures, create education for new hires, customize onboarding, develop chatbots to address IT and HR questions); finance (generate financial reports); other (generate reports for legal, compliance, and regulatory departments)
Clinical analytics: leverage conversational language to obtain analytics insights; use AI-assisted coding to automate repetitive tasks or generate new code
Consumer: analyze customer feedback by summarizing and extracting themes from online text/images; create personalized care instructions, videos, visuals, and communications; improve chatbots for member servicing of nonclinical topics; autogenerate notifications and outbound communications
