Next in health services: How GenAI can help transform digital health

Generative AI (GenAI) can transform healthcare in ways that were not possible before, as stakeholders build better, scalable digital healthcare capabilities — a survival strategy for the sector. Healthcare organizations are exploring how to use GenAI as a key capability in their digital strategies, and PwC is already working with clients on use cases.

Rethinking value across four business categories

GenAI strategy in the sector begins with rethinking value across four main business categories:

  • Amplified experience, which enable digital contact centers
  • Intelligent workflows and processes, including financial management of the digital workforce
  • Advanced analytics and intelligent insights to enable clinical recommendations and targeted interventions to help improve patient outcomes
  • Streamlined IT such as modernization of code

Healthcare organizations should use GenAI to adopt different measures of success. Today, companies’ metrics revolve around improving individual tasks, focusing on a narrow set of capabilities, organizing around IT priorities and measuring time saved. However, with the help of GenAI, these organizations may soon measure the effects of changing processes and the elimination of tasks, organizing around process transformation, broadening capabilities and focusing on metrics such as time to market.

Business model reinvention

PwC has developed guidelines for scaling GenAI designed to help organizations benefit. Organizations should build out patterns that can be applied across core business processes and that understand organizational readiness and repeatability. They will likely need a core GenAI team that includes not only technology specialists but analysts and business leaders who know what the company needs, what differentiates them in the marketplace, and who can identify the data and provide the insights needed to customize GenAI models. To make deployment and execution fast and repeatable, organizations can build a GenAI factory: an operating model built on pods to identify and assess use cases in a selected domain or line of business, which can then adapt the foundation model to help deliver value.

Healthcare organizations want GenAI to quickly steer them toward better member, patient and provider experiences, greater productivity and lower administrative costs. GenAI also can become a key component of business model reinvention by enabling:

  • Increased qualitative care delivery: Leveraging GenAI to provide enhanced support for patients, physicians, payers and other key stakeholders
  • Streamlined care operating model: Internally structuring and responsibly using GenAI technology throughout the company
  • Accelerated delivery model: Meeting production requirements for processes, decisions, capabilities, incentives and effective development structures
  • Cost of care reduction: Offering new ways to address the industry’s pressing challenge of healthcare affordability and cost control
  • Amplified employee engagement: Enabling employees to focus on higher value-added activities such as serving patients and members
  • Dynamic and context-aware workflow execution: Reengineering workflows, managing change, and recognizing what GenAI can and can’t do

GenAI is still a human-led process, and life-impacting decisions such as diagnoses and treatments should be closely evaluated and monitored by medical professionals. The emergence of GenAI increases focus on trust and the continuous assessment of performance and risks inputs and outputs. PwC’s Responsible AI toolkit, which covers strategy, controls, responsible practices and core practices, can help.

Starting points

PwC is working with clients on GenAI use cases that are scalable and represent a starting point for business model reinvention. Payers and providers are leveraging GenAI across different areas of the value chain, including:

  • Support for customer service representatives through GenAI-powered assistants that can provide sentiment analysis, question prompts, Q&A chatbots and automated documentation logging
  • Support for utilization management resources through GenAI-powered assistants that can provide summarization, policy analysis and letter generation
  • Conducting health risk assessments and member information retrieval using GenAI
  • Use of natural language processing to generate data queries (SQL queries) for backend IT functions
  • Summarizing policies, vendor contracts and state hearing content for streamlined regulatory compliance functions

Some clients are already achieving successful results from the use of GenAI. For example. a pharma company’s custom GenAI model automated the drafting of safety materials for drug-related adverse events, resulting in a 90% time saving for the company. Additionally, payers applying GenAI to the claim estimation processes gained 29% in efficiency savings.

Across industries, PwC has a long track record of helping companies build scalable capabilities and operating models to harness the potential of technologies, including GenAI, in their organizations. Learn how PwC can help you transform digital health: contact us for client conversations and to share in our host of extensive health services information, materials and tools.

Sri Murthy Guru also contributed to this article.

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Florian Quarre

Principal, PwC US

Ravi Kalakota

Principal, PwC US

Thom Bales

Principal, Health Services Sector Leader, PwC US

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