Artificial intelligence (AI) has the potential to transform how healthcare is delivered. A joint report with the European Union’s EIT Health explores how it can support improvements in care outcomes, patient experience and access to healthcare services. It can increase productivity and the efficiency of care delivery and allow healthcare systems to provide more and better care to more people. AI can help improve the experience of healthcare practitioners, enabling them to spend more time in direct patient care and reducing burnout.
Topic Healthcare analytics
Income, employment, education, food security, housing, transportation, safety, and social support are all factors that affect health and well-being.
John E. Gallina, EVP and CFO at Anthem shares his perspective on the changing healthcare landscape and opportunities to reduce cost, reinvent care delivery, personalize the consumer experience, and engage with partners to create change.
What issues will matter for the healthcare industry in the United States through the year and into the 2020s?
McKinsey conducted a national survey to understand the impact of unmet social needs on consumer health outcomes, utilization, and preferences. Given the link between unmet social needs and lower socioeconomic status, respondents for this survey included adult Medicare and Medicaid beneficiaries as well as low-income adults who were uninsured or who had purchased insurance through the individual market.
Dr. Jim Weinstein, the senior vice president for Microsoft Healthcare, discusses his perspectives on how to create a sustainable health system and how technology can help healthcare stakeholders improve productivity.
How healthcare investing efforts can drive innovation: a conversation with Matt Holt, President, Private Equity, New Mountain Capital
Collaboration, automation, and innovation may hold the keys to the future of healthcare investing. Matt Holt, managing director and president of private equity at New Mountain Capital, leads healthcare investing for the firm and shares his views.
At face value, the problem is simple: Getting the right care to the right people at the right cost—but anyone who has touched or worked in the industry knows that it’s a lot more complicated. As part of our series looking at productivity, Dr. Ron Walls, COO at Brigham Health discusses the opportunities to improve healthcare productivity—and the steps that leaders could be taking today to improve healthcare delivery.
Catherine Jacobson, president and CEO of Froedtert Health, and Thomas Zenty, CEO of University Hospitals, explain how their academic medical centers and academic-based health systems are finding their niche in the healthcare ecosystem. As these centers develop, how do changing consumer expectations and social determinants of health change their vision for the future?
The president and CEO of Cincinnati Children’s Hospital explains how social determinants of health (e.g., education, housing, social support) affect children’s health outcomes, and how organizations that invest and intervene early can generate both near- and long-term value.
Despite the promise of digitization, paper forms will remain for many years. Payers that find a better way to handle both paper-based and digital information will have a competitive advantage.
Using advanced analytics and digital capabilities to improve the design and implementation of care management programs can promote better patient outcomes and an improved return on investment (ROI).
Creating or participating in a digital health ecosystem can allow payers to take advantage of their central position in the healthcare landscape and expand in new directions.
Next-generation member engagement tools empower members to make higher-value care decisions and enable health insurers to improve care quality, increase member satisfaction, and reduce medical spending.
Process automation at scale is now feasible for most payers. When coupled with other next-generation digital tools, we estimate that it may enable many payers to reduce operational costs by up to 30 percent within five years.
Omnichannel interactions are fundamentally improving the consumer experience in many industries. Payers should act now to keep up with rising consumer expectations.
Although end-to-end digital claims management is still a distant vision, much can be gained from digitizing portions of the claims process today.
Smart hospitals make extensive use of innovative technologies to improve care quality and patient experience while reducing costs.
Hospital care is changing both rapidly and radically. Because of innovations in care delivery and organisational structures, future hospitals are likely to be very different from those of today.
Technology-driven innovation holds the potential to improve our understanding of patients, enable the delivery of more convenient, individualized care—and create $350 billion–$410 billion in annual value by 2025.
Artificial intelligence (AI) is increasingly being adopted across the healthcare industry, and some of the most exciting AI applications leverage natural language processing (NLP). Simply put, NLP is a specialized branch of AI focused on the interpretation and manipulation of human-generated spoken or written data. In this infographic, we describe a few promising NLP use cases for healthcare payers and providers. We elaborate several specific approaches and their associated applications. Finally, we lay out a case study describing how we have used NLP to accelerate benchmarking clinical guidelines.
Society is aging and healthcare costs keep rising. By digitizing the system, health services can be provided at lower cost and higher quality. A new study reveals the areas for and extent of potential improvements.
Although the opioid crisis in the US is gaining increased attention, the steps taken to date to combat it are insufficient. Our research suggests that much broader—and bolder—action is required.
Machine learning is transforming the healthcare industry by changing the way care is delivered, and its impact is poised to increase.
Careful analysis of health insurers’ claims data can provide important insights into the opioid crisis by identifying patterns that could help shape strategies to combat opioid dependence and abuse.
Radiology is essential to patient care, but where there's variation in spend, there's potential opportunity for payers to decrease costs.
Extending the use of episode analytics beyond alternative payment models: A scalable architecture for improving payer performance
Payers (and providers) that have dismissed bundled payments or treated it as a narrow part of their strategies may under-appreciate the value of episode analytics in improving core business functions.
Low back pain is common and costly. By providing a longitudinal view of treatment patterns, patient journey analytics can identify opportunities for timely, high-quality, cost-effective interventions.
As more data about individuals with special care needs becomes available, the latest innovations in data analytics can be used to transform care delivery for them in a financially sustainable way.
At health insurers, artificial intelligence can strengthen claims management by systematically identifying and correcting errors while avoiding ineffective interventions.
In this interview, Otto Bitterli (Chairman of Sanitas Health Insurance) discusses the company’s digital transformation and its commitment to being an innovative long-term partner to its customers.
An analysis of the individual market health plans being offered across the U.S.reveals that the trends toward narrowed hospital networks and managed care continue.
Analysis of exchange premiums indicates that overall prices will continue to increase in 2017. Despite this, some consumers will see their premiums decline given the effect of government subsidies.
Analysis of exchange plans indicates that a majority of carriers are continuing to shift toward managed offerings, and consumers will see less unmanaged plan designs available to them than in previous years.
Analysis of exchange carrier participation nationwide indicates that the overall number of carriers has dropped below 2014 levels. However, a majority of markets will continue to have more than one carrier participating.
Traditional arguments for EHR implementation such as efficiency gains and meaningful-use incentives are insufficient to maximize a health system’s returns on its technology investments. However, clinically and operationally oriented sources of value can generate an additional $10,000 to $20,000 per bed in annual margin.
While the individual market is still in flux, careful analysis of carriers’ performance reveals several factors are associated with better results.
2014 performance in the individual market varied among payors – most had negative margins, but ~30% of carriers' margins were positive.
Based on nationwide 2016 individual exchange rates, here are overall and state-by-state insights on carrier participation, price leadership shifts, gross premium changes, and the impact of subsidies on 2016 rates.
Facts on the shift toward HMOs on the public exchanges.
Between 2013 and 2014 absolute enrollment and revenue grew by 17 million lives and $86 billion respectively.
Despite higher increases in lowest-price plan gross premiums this year, a greater share of consumers are seeing less expensive lowest-price silver net premiums.
The mix of carriers and plans is continuing to change, with nearly half of consumers seeing a new entrant, and plan types becoming more managed.
Updated 2015 network data, including a comparison of networks offered on the 2014 and 2015 exchanges, insights into how networks’ pricing structures are evolving, and insurer and provider participation.
This brief provides a full view into the 2015 exchange landscape.
State-by-state data and analysis on approved 2015 products offered on federal and state Individual exchanges
Survey findings shed light on how a variety of factors could affect the decisions consumers make about enrolling: eligibility for subsidies, penalties for not enrolling, satisfaction with 2014 plans, and increases in premium rates.
An analysis of the 2015 exchange landscape, with a view to gaining a preliminary understanding of how the 2015 OEP will differ.
A close look at the public exchange network in 2014.
This updated view of the network configurations being offered on public exchanges across the country suggests that consumer choice of health plan design is expanding.
Our fourth intelligence brief on exchange dynamics shares observations of the individual market through the mid-point of open enrollment.
Our third intelligence brief on ACA exchange dynamics sets forth five observations based on analysis of new network configurations across 20 urban rating areas.
Our second brief on exchange dynamics is based on a comprehensive analysis of all exchange offerings across the entire US—more than 21,000 unique qualified health plans filed on the public exchanges in all rating areas.
This brief comprises an initial set of analyses regarding the structure, competitive dynamics, and pricing on the exchanges, and their implications.
The trillion-dollar prize: Using outcomes-based payment to address the US healthcare financing crisis
There is growing consensus that transitioning to outcomes-based payment is fundamental to driving cost-reducing innovation among healthcare providers and achieving a financially sustainable healthcare system.