Incorporating artificial intelligence (AI) into the healthcare system can transform how we develop, administer, and operate at every level of care. AI is already being used to optimize aspects of the health system and reduce administrative and developmental burdens on doctors, researchers, and providers who can then focus on improving treatments and patient outcomes while lowering overall costs.
Fraud in the healthcare industry is a massive problem, costing an estimated $380 billion annually, which raises premiums and other out-of-pocket medical expenses for consumers. AI can be integrated into systems to recognize and flag fraudulent activity, including suspicious data patterns or insurance claims. Real-time monitoring minimizes the time and costs associated with fraud detection while allowing resources to be redirected toward authentic claims, streamlining the process and improving customer satisfaction. By identifying common fraudulent billing patterns, such as charges for procedures that are not performed, AI can save billions of dollars for the industry each year – savings that will allow the overall cost of care to decrease for consumers.
Fraud detection is far from the only area where AI can reduce unnecessary and costly expenditures. Administrative functions are estimated to account for 15 to 30 percent of healthcare costs; they can be optimized with AI-enabled systems. Administrative activities are financially costly, but also a significant burden on physicians with 93 percent reporting they feel regularly burned out.
McKinsey & Company estimates that prior authorization, a timely and labor-consuming process for providers, could require up to 75 percent less manual labor with the incorporation of AI. Sixty-five percent of U.S. hospitals already use predictive models to identify high-risk outpatients to inform follow-up care, simplify billing methods, and facilitate scheduling. AI’s quality improvements are perhaps even more impressive, with AI demonstrating higher diagnostic accuracy than human specialists in breast cancer and melanoma detection research. The benefits of early detection for better patient outcomes and avoiding costlier care are further examples of AI’s promising ability to save money and improve outcomes across the healthcare industry.
On the research and development front, AI is being implemented in clinical trials to increase speed and efficiency. Drug development is a long, resource-intensive process with high rates of failure across stages. Incorporating AI can mitigate many of these costs with innovative approaches. One successful strategy is using AI to identify and match potential volunteers to relevant clinical trials. This helps clinicians navigate vast pools of candidates and trials, resulting in accurate enrollment and increasing the speed of research and drug development. Sanofi uses digital “twinning” for faster and safer assessments of novel drug candidates. Researchers create a virtual patient population based on actual patients still in studies. The digital population can undergo drug testing before patients are moved into a clinical trial, allowing for more accurate first assessments and potentially reducing the number of patients needed.
Sanofi isn’t the only one using AI tools to improve research. Genomics England, a trailblazer in human genome research, is currently using one of Amazon Web Services’ foundational model offerings, Anthropic Claude, to streamline their research. This generative AI model can process millions of pages of peer-reviewed literature to identify the gene associations most likely for further investigation, thus increasing the efficacy and accuracy of their future genetic testing.
The potential for AI to improve healthcare outcomes, identify fraud, and reduce costs cannot be overstated. Its applications span numerous areas, and its impact is already felt across the industry. To maximize efficiency and deliver optimal results for all stakeholders, we must continue developing thoughtful, innovative approaches to integrating AI into healthcare that allow for emerging technologies and advancements.
Read HIA’s report, Use Cases for AI Tools to Improve Health Care, to learn more about how AI is used throughout the healthcare industry.