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Consumerism will force healthcare's hand on interoperability, Forrester finds at HIMSS19

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Forrester Research has published a report summing up its impressions from the HIMSS19 Global Conference & Exhibition. Experts said they came away from the show convinced that big momentum is building behind interoperability, and it's not coming from the places one might expect. Health systems will need to do better with the management and sharing of more data than ever if they hope to stay competitive in a value-based care landscape where patients have more choice than ever about where they get their care, according to the study. WHY IT MATTERS As interoperability continues to gain steam, it's set to boost the profiles of an array of other key technologies, said Forrester researchers. At HIMSS19, it was clear that tools "supporting data management and interoperability, including cloud and AI, showcased their ability to add value and hit on the quadruple aim: improving the customer experience, driving better outcomes, lowering costs, and supporting the whole care team," they said.


Why AI will make healthcare personal

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For generations healthcare has been episodic – someone gets sick or breaks a bone, they see a doctor, and then they might not see another one until the next time they get sick or injured. Now, as emerging technologies such as artificial intelligence open up new possibilities for the healthcare industry in the Fourth Industrial Revolution, policymakers and practitioners are developing new ways to deliver continuous healthcare for better outcomes. Consumers already expect access to healthcare providers to be as smart and easy as online banking, retrieving boarding passes and making restaurant reservations, according to Kaiser Permanente CEO Bernard J Tyson. Nearly three-quarters of Americans with health insurance (72%), for example, say it's important that their health insurance provider uses modern communication tools, such as instant message and two-way video. Innovative healthcare organizations such as Kaiser Permanente are listening.


PYMNTS.com

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Ever since Amazon turned its gaze to healthcare, questions about the eCommerce operator's plans and intentions have outnumbered answers. That's still true, and may remain so for the time being, but this week new details emerged that, at the least, is shedding light on Amazon's healthcare vision. Here's the scoop, courtesy of court testimony: Amazon wants to, in the words of The Wall Street Journal, "redesign health insurance." And that's only one possible aim -- others involve using artificial intelligence to improve diagnoses and the overall patient experience, but we'll get to that in a bit. Among the biggest ongoing mysteries for even the most sophisticated Amazon watchers is the specific purpose of the independent healthcare company that includes Amazon, Berkshire Hathaway and JPMorgan Chase, a venture that was announced last year.


China: Big data & AI to help combat health insurance fraud

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The announcement came after Hu Jinglin, director of the National Healthcare Security Administration, made a pledge during the ongoing annual two sessions in Beijing that it will severely crack down on fraudulent practices affecting the country's healthcare insurance funds. The health insurance sector has long been plagued with various fraud cases, like fabricated medical services and documents and fake invoices. Last November, two hospitals in Shenyang, capital of northeast China's Liaoning Province, were accused of insurance scams, which prompted the regulators to audit other medical institutions. While much progress has been made since supervision was tightened, the overall situation remains "grim", so it will be a top priority for the authorities to carry on the fight against insurance fraud in 2019. The administration will partner with more third-party service providers like Ping An HealthKonnect to identify potential fraud risks and gain better control of medical insurance costs by leveraging their advanced technologies in areas of big data and artificial intelligence.


Addressing the promises and challenges of AI

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A three-day celebration event this week for the MIT Stephen A. Schwarzman College of Computing put focus on the Institute's new role in helping society navigate a promising yet challenging future for artificial intelligence (AI), as it seeps into nearly all aspects of society. On Thursday, the final day of the event, a series of talks and panel discussions by researchers and industry experts conveyed enthusiasm for AI-enabled advances in many global sectors, but emphasized concerns -- on topics such as data privacy, job automation, and personal and social issues -- that accompany the computing revolution. Kicking off the day's events, MIT President Rafael Reif said the MIT Schwarzman College of Computing will train students in an interdisciplinary approach to AI. It will also train them to take a step back and weigh potential downsides of AI, which is poised to disrupt "every sector of our society." "Everyone knows pushing the limits of new technologies can be so thrilling that it's hard to think about consequences and how [AI] too might be misused," Reif said.


ML helps health plans tackle SDOH, improve outcomes

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With the passage of the Chronic Care Act, Medicare Advantage plans have been scrambling to figure out how to offer supplemental benefits to their members. Passed as part of a Bipartisan Budget Act last year, the Chronic Care Act promotes the use of benefits that maintain health or keep a beneficiary's health from deteriorating, and the benefits don't have to be health-related. Instead, they can include help for social determinants of health that include housing, nutrition and transportation. Under the act, the supplements can also be tailored to the individual, when it comes to qualifications. The same benefits don't have to be offered to every beneficiary, he says.


H2O Users Share Data Science Stories

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When it comes to analytics tools, data scientists have a plethora of options available to them. Features that may appeal to one data scientist don't necessarily work for another. When it comes to offerings from H2O.ai, users expressed different reasons for their choices. Last week, Datanami was a guest at H2O.ai's annual user conference, called H2O World, and had a chance to talk with several customers, including Ruben Diaz, a data scientist with Vision Banco, and Bharath Sudharsan, director of data science and innovation at Armada Health. Vision Banco is one of Paraguay's largest banks, with consumer and micro-finance lines of business.


Change Healthcare unveils AI tool for dual Medicare-Medicaid enrollment: Change Healthcare launched a tool Aug. 6 that combines artificial intelligence and behavioral science to help payers identify and enroll Medicare Advantage members who are eligible for both Medicare and Medicaid.

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Change Healthcare launched a tool Aug. 6 that combines artificial intelligence and behavioral science to help payers identify and enroll Medicare Advantage members who are eligible for both Medicare and Medicaid. Using AI, the Dual Enrollment Advocate solution is 93 percent accurate in flagging individuals who qualify for full or partial dual eligibility. Change Healthcare member engagement teams will use the technology to support the company's health plan customers. "We're applying data science, behavioral science and consumer-experience design to solve one of the trickiest problems for Medicare Advantage plans, which is how to accurately identify people for Medicaid eligibility," said Keith Roberts, vice president of engagement at Change Healthcare. "AI and machine learning can't do it alone. Behavioral science can't do it alone. And health plans and legacy systems can't do it alone. The time has come to bring these healthcare IT and scientific disciplines together to help solve a critical business challenge for our customers."


How AI Can Battle A Beast--Medical Insurance Fraud

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What if the patient was given a test, but it was actually a less expensive version than what the hospital billed for? Finding the answers to these kinds of questions can involve gathering and analyzing massive amounts of data from myriad sources. Traditionally, human fraud examiners have taken on these tasks, as they specialize in sifting through healthcare compliance and medical billing documents to determine what's legit and what isn't. Healthcare is built around helping people stay well or recover following illnesses and injuries, but like other industries it is susceptible to a range of fraud that can cause financial harm and drive up costs in the system. "Fraud, waste, and abuse is a huge contributor to unnecessary costs and the rise of spend within healthcare in the U.S.," says Arielle Trzcinski, senior analyst at Forrester.


Can AI Cure What Ails Health Insurance?

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But by 2017, that price tag had ballooned to $3.5 trillion flowing to and from insurers, Medicare and Medicaid via patient premiums and claims payouts to healthcare providers and drug companies. All told, keeping the U.S. healthcare system spinning took six billion insurance-related transactions (an increase of 1.2 billion transactions from 2016), according to the nonprofit Council of Affordable Quality Healthcare. Could artificial intelligence (AI) technologies help control the industry's rising costs and tsunami of paperwork? Insurers could save up to $7 billion over 18 months using AI-driven technologies by streamlining administrative processes, according to a recent Accenture study. By automating routine business tasks alone, the study projects that health insurers could save $15 million per 100 full-time employees.