AI offers health care industry new ways to control costs, manage care

Originally published in MiBiz.

Get ready for the rise of the machines in the health care industry.

The future of health care could very well depend on it, as artificial intelligence ushers in a new era of cost control and care management.

That’s the assessment of Marti Lolli, the chief marketing officer and senior vice president for consumer and government markets at Priority Health in Grand Rapids.

“Artificial intelligence will really take health care to a new level through personalization,” Lolli said in a presentation at the recent annual health benefits seminar hosted by Advantage Benefits Group Inc.

In her talk, Lolli spoke about how AI and digital technologies are altering health care.

As health care costs and spending continue to rise, artificial intelligence will play a greater role in nudging consumers forward on the “most difficult piece of the puzzle” in controlling costs, which is changing personal behaviors that affect an individual’s health. It’s an area of the business where “there is no perfect cure,” Lolli said.

Artificial intelligence allows health plans and organizations such as Priority Health to collect and analyze volumes of data and use digital tools to learn about individuals, their habits and lifestyles. That could lead to customized care programs for people with high-cost chronic medical conditions such as diabetes and doing away with “one size fits all” approaches. Through AI, Priority Health can better target diabetics or people at risk for developing Type 2 diabetes by using personalized care management that has a higher likelihood of success compared to traditional treatments.

“What we’re moving toward through machine-learning is understanding who’s most likely to respond to this program, who’s most likely to be impacted and change their life,” Lolli said. “One of the biggest problems we’re trying to solve is the conundrum of health care costs, and that’s where I believe we can start leveraging AI, digital and data to start moving the needle.”

The emergence of artificial intelligence in health care was one of the top dozen issues that PricewaterhouseCoopers predicted would affect the industry in 2018, from the business side to clinical decision-making.

“In health, this technology is gaining momentum and has the potential to significantly alter the industry, from the exam room to the back office to the supply chain,” according to the 2018 annual report from PWC’s Health Research Institute. “In fact, health care’s back offices and supply chains are where AI is gaining traction now, generating quiet efficiencies that don’t garner the same headlines as visions of virtual physicians and robotic nurses but have profound potential to disrupt the industry.”

PWC cites as an example care providers using AI to analyze pathology and radiology test results quicker and more accurately. Also, pharmaceutical companies can use the technology to analyze, follow up and report on adverse drug events, according to the report.

PWC researchers note AI is best used for repetitive tasks because it “doesn’t forget, tire, get bored with tasks or develop carpal tunnel syndrome.”

Entrepreneurs have been developing mobile apps that use AI for wellness and health management. Among them is HealthJoy, a Chicago company that presented at the Advantage Benefits Group seminar, and Jool Health Inc., an Ann Arbor company supported by investors from West Michigan.

Jool Health, which last fall raised $4.5 million in venture capital to support upgrades and accelerate sales and marketing, offers a program that uses AI to enable employers to tailor their wellness initiatives to individual employees based on their lifestyles, habits and health status.

Just three weeks ago, the U.S. Food and Drug Administration for the first time permitted the marketing of a medical device that uses AI to detect an eye disease in diabetics.

Priority Health has begun using AI to better manage costs and improve wellness and care management.

Historically, the way insurers addressed rising costs has included discounts; pushing the use of lower-cost generic drugs; capitation in provider reimbursements; benefit designs that encourage wellness; and the use of low-cost care providers, preventative care, and chronic disease management, which accounts for a large share of health care expenditures.

Health savings accounts and high-deductible health plans were supposed to “bring a new revolution” in health care, Lolli said, yet costs have continued to rise to the point where a family health plan in America now costs an average of more than $18,000 a year.

Of late, the big industry push has been for virtual care that offers greater access and convenience for patients at a lower cost, as well as quality and price transparency that allows people to shop around between care providers, particularly for elective medical procedures.

The push for greater consumerism has led to consumers increasingly viewing health care the same way they view other purchases in the digital age, Lolli said.

That’s where AI comes in. If social media sites and companies such as Starbucks, Amazon and Netflix can use AI to learn about the habits of their customers and use the knowledge to better reach out to them, health care organizations wonder how they could use the same tools in their industry.

As Priority Health and others push for greater consumer engagement, they need to layer on AI — or “machine-learning … where we get smarter over time by providing nudges in the right direction for folks” — to better understand their conditions and become more engaged in their health, Lolli said.

“And over time, we learn how that works and the machines learn, and their predictive algorithms go along with that to start knowing more and more about how this works,” she said. “We’re starting to build models about someone’s likelihood to respond to that nudge.”