Generative AI will profoundly change healthcare operations

Fast-paced advancements in generative AI will change the core operations of every healthcare organization. AI-driven technology is not just a side project anymore. AI solutions including generative AI are finally advanced enough to deploy at scale and provide a frictionless customer experience.

According to a recent analysis by EXL, a leading data analytics and digital solutions company, healthcare organizations that embrace generative AI will dramatically lower administration costs, significantly reduce provider abrasion, and improve member satisfaction. EXL predicts that if organizations fully adopt a digital strategy and optimally leverage technology, they could reduce overall administrative expenses by 40% to 50% in the next five years.

generative AI will significantly change how healthcare operations are conducted, establishing a new level of benchmark performance by which all payers and providers will be measured.

Healthcare operations have been slow to change but now are catching up

Unlike banking and financial services, healthcare operations have been slower to adopt AI-backed digital technology until now. EXL works with many leading healthcare payers and providers, and we have seen a substantial increase in these organizations wanting to know more about generative AI and the benefits of digital transformation.

The timing could not be better. Healthcare payers and providers are facing financial headwinds that will not subside just from cost costing or reducing labor. Plus, the implementation of cloud technology and the ability to use data at scale has markedly improved. Adding generative AI to this mix creates a catalyst to dramatically boost productivity and lower costs by assisting human interactions with automation.

How AI-driven technology will impact healthcare operations

For healthcare payers, every enterprise is facing several external and internal challenges, especially ongoing issues with the customer experience for navigating health plans, understanding benefits, and accessing services. They also are looking for more effective ways to infuse digital solutions across the care continuum to minimize delays, create better coordination, and improve health outcomes.

On the provider side, organizations are seeking differentiation by offering hyper-personalized patient outreach. They want to create engagement that is more meaningful and impactful to each individual patient regarding their respective health issues and care plan.

Whether payer or provider, all of these activities are data-driven, complex interactions. Digital solutions based on generative AI technology make these exchanges happen much more easily and effectively. Unlike prior chatbots and other digital point solutions, generative AI technology is transformative because it unlocks the power of unstructured data to create new content.

Today’s data-led digital solutions, based on natural language processing and speech recognition, can handle complexities in medical records, contract language, documents, and policies. In addition, large language models can both summarize massive amounts of data and create new, original content. How all of this will play out is yet to be determined, but AI-based customer issue resolution is already becoming more accepted and desired rather than relying on human interaction.

EXL helps organizations achieve success with generative AI

The EXL Health team works with payer and provider clients, leveraging our deep healthcare operations, data, analytics, and technology expertise. We serve in partnership with healthcare organizations, offering both professional insights and digital solutions to drive transformation.

Here’s an example. A payer organization was working with an existing technology provider but only achieving incremental benefits. We guided the roadmap to prioritize the best use cases for using generative AI to more quickly achieve full deployment. With our experts, a payer organization achieved a 40% cost reduction through their generative AI-enabled digital solution for their customer experience capabilities.

We also implemented our own AI solution, EXELIA.AI™, to help solve the payer’s contact center issues. Specifically, we addressed the customer experience of healthcare providers who were seeking pre-authorization status to provide patient care.  EXELIA.AI is a pre-trained healthcare solution that mimics human-like interactions through voice and chat.

By using this solution, the payer was able to scale AI containment—that is fully containing calls by artificial intelligence—between 60% to 80% in the first six months of deployment. Moreover, healthcare providers reported an 80% satisfaction rate with this frictionless AI experience– a rate higher than a typical live agent experience.

Outside of transforming the contact center experience, EXL is now working to deploy generative AI to create in-context clinical summarization, which has the capability to significantly boost registered nurse productivity within utilization management workflows.

To learn more about how generative AI and digital transformation can significantly reduce operational costs in the next five years, read our white paper. For more information about EXL’s work to optimize healthcare call centers, read our case study. Learn more about how EXL can put generative AI to work for your business here.

About the Authors:

Anita Mahon is executive vice president and global head of healthcare business unit at EXL, a multinational data analytics and digital operations and solutions company. Jay Nambiar is the chief technology officer for the healthcare business at EXL.