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Healthcare affordability remains a troubling and persistent industry issue for payers, providers and patients. Our 2024 US healthcare consumer survey tells us that one-third of Americans find their healthcare unaffordable, and another third say they can’t afford to pay more than they do now. Those who can’t afford their healthcare are often the patients who need it most. Our consumer survey reveals that 44% of consumers with health issues that significantly impact their quality of life delay getting care due to financial constraints, and 61% of consumers with health issues that restrict their quality of life have trouble managing their medication costs.
The challenge for consumers is difficult but not insurmountable. Health plans and health systems have an unprecedented opportunity to help make healthcare more affordable through artificial intelligence (AI) and advanced machine learning tools.
There are many ways that AI and technology can help bring healthcare costs down and better serve patients who struggle to afford their care, especially now, as value creation in the healthcare ecosystem is being reconfigured into a network capable of meeting rising demand and coping with increased cost pressure and rising consumer expectations.
Here are some key areas to consider as you incorporate AI into your cost containment and patient care strategies.
Preventive care: Help spot problems before they start
AI can help identify high-risk patients in need of preventive care based on their medical history and demographics. Early detection improves patient health before costly medical treatment is needed for serious or chronic disease. Identifying issues early can empower patients to embrace healthy behaviors, manage risk factors such as high blood pressure or high blood sugar, avoid worsening conditions and live longer.
Personalized care: Predict — and help prevent — crises
AI can help lead to better patient diagnosis and treatment by analyzing vast amounts of data, identifying patterns and providing personalized insights. Personalized care can bring considerable improvement to health by enabling more balanced and careful evaluations of potential treatment options. By considering the patient’s genetic makeup and contributing factors such as lifestyle and environment, tailored treatments can address each patient’s individual needs and characteristics. Such an approach can allow for more precise diagnoses, effective interventions and a potential reduction in expenditures before issues become critical. AI is expected to play an important role in precision medicine — improving overall patient experience.
Predictive care: Break down barriers in clinical trials
Researchers are using AI to help recruit patients to clinical trials who otherwise may be hard to find. For example, tools use natural language processing to transform complex trial-inclusion criteria into data search queries that locate eligible patients using electronic health records. This AI-powered analysis enables researchers to reach out and recruit a wider and more diverse pool of trial participants. The large language models require robust, diverse data sets to target scarce resources more effectively and enhance affordability. Data that includes marginalized populations is crucial to developing useful algorithms to better address the needs of vulnerable populations. Initiatives such as the National Minority Quality Forum — which works to increase participation in clinical trials among minority populations — are essential to improving the quality of AI predictions regarding health outcomes.
Proactive care: Empower community health workers
The World Economic Forum's Digital Health Alliance recently published a report highlighting case studies and implementation models for community health workers who are helping patients manage diabetes and high blood pressure. The report found that equipping community health workers with commercial digital health tools can empower them to be more effective. Notably, six of ten digital health tools studied not only monitor care gaps but also alert providers — potentially offering a chance to intervene before a costly emergency room visit.
Point of care: Close the access gap
AI is changing where, how and by whom care is delivered. Many patients live in rural areas far from health care services or lack social support. AI is helping these patients long-distance, through tools like AI-driven smartphone apps that can assess symptoms, diagnose various medical issues and suggest personalized care. Sensory wearables can remotely monitor blood pressure and heart rate in patients with heart failure and chronic obstructive pulmonary disease (COPD). AI helps physicians keep track of a patient’s status and progress and improve patient outcomes. Remote monitoring brings down the cost of care by reducing the need for hospital admissions, emergency room visits and numerous follow-up appointments, particularly for patients with chronic conditions.
The tools to make healthcare more affordable and effective exist. Let’s use them.
Contact us to learn more about what you can do to harness the power of AI to improve affordability for your members and patients.
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