Published on December 7, 2023, 2:09 pm

Payers and providers in the healthcare industry are starting to embrace generative AI technology, allowing them to offer personalized treatment and tailored communications that empower patients. However, there are still concerns about how to effectively utilize this technology while ensuring patient data privacy and complying with regulatory requirements.

Despite these concerns, generative AI is a transformative technology that cannot be ignored. Organizations that fail to embrace it will put themselves at a significant disadvantage. Generative AI has the potential to revolutionize healthcare delivery and operations by enabling patient-centric care through personalized treatment, improved communications, and enhanced empowerment for patients.

In the near future, digital solutions based on generative AI will become commonplace in all aspects of healthcare. One way generative AI can be used is to improve patient care through next best action recommendations. Using analytics and large language models, healthcare professionals can make tailored recommendations for preventative screenings and services.

Generative AI can also enhance the customer experience by speeding up interactions in contact centers. By securely accessing relevant information in an AI-driven omnichannel environment, both patients and plan members will have a more efficient experience.

Another area where generative AI can make a difference is in streamlining the pre-authorization process. Currently, this process often causes delays in patient care due to information exchanges between providers and plans. Generative AI can produce clinical summaries that enable faster and more effective clinical reviews, leading to prompt approvals for needed care.

Physicians can also benefit from generative AI by using a digital scribe to capture patient documentation. This technology allows healthcare providers to focus more on patient care rather than paperwork. Additionally, an AI-based digital scribe has the potential to uncover valuable insights about patients, leading to better overall care.

EXL, a leading data analytics and digital solutions company, has developed an AI platform that combines foundational generative AI models with expertise in data engineering, AI solutions, and proprietary data sets. Their digital solutions offer improved productivity, unlock new insights, and create hyper-personalized customer experiences.

EXL has already deployed over 50 AI-based accelerators in the market, including tools like EXELIA.AI™ for improving call center operations and XTRAKTO.AI™ for intelligent document processing in back-office operations. For healthcare payers and providers, EXL offers AI-based solutions for clinical operations that transform patient or member management through automation, clinical summarization, decision-making support, audits, and operational efficiency controls.

EXL has been working with clients across industries to implement generative AI solutions at an enterprise-wide level. In the healthcare industry, their deep domain expertise helps identify areas of improvement and friction points that can benefit from generative AI technology.

To get started with implementing a generative AI solution, it is recommended to begin with a small project in a secure environment. Focus on administrative operations that are expensive and heavily reliant on manual activity with large amounts of unstructured data. For example, creating an AI-based digital agent for annual membership and enrollment processes can be a good starting point. Other options include using generative AI for clinical summarization work, referral management, or optimizing the supply chain.

For effective and scalable AI solutions, it is important to establish a data strategy, data governance, data engineering capabilities, and a cloud infrastructure aligned with the organization’s vision and goals.

To learn more about how EXL Health can drive data-led transformation in your organization or to explore AI solutions in healthcare case management, refer to the provided links.

About the Authors:
Anita Mahon is the Executive Vice President and Global Head of Healthcare Business Unit at EXL. Dave Jackson is the Vice President and Head of Healthcare Consulting at EXL.

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