Amber Nigam, CEO, and co-founder of basys.ai, a Harvard-based company, is utilizing generative AI to streamline prior authorization and utilization management processes for health plans. The healthcare industry is known for its complexity, with processes like case management, care management, and utilization management being particularly labor-intensive and inefficient. However, Nigam believes that the use of AI and large language models can revolutionize these processes and improve efficiency within the healthcare industry.
Case management involves coordinating patient care and often involves administrative tasks like data entry and paperwork, which can detract from patient care. Care management focuses on chronic conditions and requires constant monitoring and documentation. Utilization management involves reviewing patient cases to determine necessary treatments, which can be time-consuming and require manual reviews and approvals. These processes are essential but are in need of disruption.
Generative AI and large language models have the potential to automate many of the administrative tasks within healthcare, reducing the operational burden. These technologies can analyze patient data, suggest personalized care plans, monitor patient data for any changes, and review patient cases more efficiently. AI-driven automation is reducing the necessity for geographical arbitrage, where companies outsource tasks to regions with lower labor costs, as AI can perform many of these tasks more accurately and quickly.
The healthcare industry is on the cusp of a major disruption, with companies that fail to adopt generative AI and LLMs at risk of becoming obsolete. Legacy companies must recognize the importance of this technological shift, as we are seeing a trend of large healthcare companies acquiring smaller startups to access cutting-edge technologies. Embracing the future of healthcare operations means identifying potential use cases for generative AI, setting clear goals and key performance indicators, ensuring compliance with regulations like HIPAA, and providing training to healthcare professionals to effectively use these new technologies.
As generative AI and LLMs reshape healthcare operations, companies that innovate and embrace these technologies can succeed in a landscape defined by efficiency and patient-centric care. There is a significant learning curve involved in integrating AI technologies into healthcare, with challenges such as patient and data privacy, as well as the need for training for healthcare professionals. The future of healthcare belongs to those who are willing to adapt and innovate, as tech-savvy startups pave the way forward with groundbreaking innovations. The question remains, will legacy giants evolve or fade into obscurity in the face of technological advancements in healthcare.
