Outcomes

A Google search for “healthcare” will give you 1.76 billion hits. And, interestingly enough, the top results (excluding the ads) are all offering health insurance plans.

Yet, none of the results on the first page mention anything about the high cost of healthcare in the United States. Healthcare expenditures grew 4.6% in 2019, reaching $3.8 trillion, which was 17.7% of the nation’s total Gross Domestic Product (GDP).

Back in 1960, that number was just 5%.

The National Healthcare Expenditure (NHE) is predicting that costs will reach $6.2 trillion and account for 20% of GDP by 2028.

Public policy experts, government officials, sector leaders, business executives, and citizens from all walks of life have been seeking healthcare reform for years. How can we rein in costs while also saving lives?

Enter AI

Now, artificial intelligence and machine learning are being used to reform the healthcare system in ways thought unimaginable even five years ago.

Using algorithmic architecture, artificial intelligence works just like our brains. Our brains receive signals in our neurons to process the data we see. As we continue to experience new things, our brains process new information based on previous data to make informed decisions. The same happens with deep learning. The more data the AI has to process, the more accurate it becomes in its predictions.

Now medical professionals using AI can predict when you’ll come down with a sickness or need surgery up to 12 months in advance.

As Accurate as an Ophthalmologist

The Google Brain initiative developed an AI that can accurately and automatically detect diabetic retinopathy and diabetic macular edema. It’s accurate up to 97.5% of the time, and given that high level of accuracy, it’s unlikely to miss diagnosing a patient or over-diagnose a disease.

Not only that, but it may be able to see things that doctors aren’t able to with their own eyes. The Google Brain team isn’t entirely certain what the AI is looking at specifically. They just know the AI is coming to the correct diagnoses.

Pinktober Year ’Round

October kicks off Breast Cancer Awareness month. But rather than “saving the ta-tas” just one month out of the year, AI and deep learning can help women year-round.

In breast cancer screening, AI enables the review and translation of mammograms up to 30 times faster and with 99% effectiveness. That level of accuracy is hugely significant not only medically, but for the patient as well.

Women can feel confident in their radiology reports and avoid false positives, as well as painful biopsies. Imagine how much money can be saved with more rapid and more accurate diagnoses.

Big Pharma and AI

Big pharma is already harnessing the power of artificial intelligence and genomics to develop precision cancer therapies to help provide more effective cancer treatments.

AI is compressing the cost and clinical trial timeline, removing much of the trial and error in drug development.

AI Helps Reduce Medical Fraud

Unfortunately, fraud is a huge cost to the healthcare system. The National Health Care Anti-Fraud Association estimates that fraud costs the nation about $68 billion annually. And fraudsters will do anything to get patient data.

Human error contributes substantially to medical fraud. With AI, that human error can be eliminated, and the cost of fraud reduced.

Third-Party Administrators Using AI

Most recently, Third Party Administrators (TPA’s), serving companies that self-fund employee health plans (meaning they pay healthcare costs directly rather than pay an insurance company to cover them), have deployed machine learning. TPA’s process claims, reduce expenses with cost-containment strategies and advise on health plan design. New tech-first TPA’s are using artificial intelligence to automate processes, reduce claim abuses, and improve the health plan experience.

A new TPA called Marpai Health uniquely uses deep learning, the most advanced AI, to save lives, improve lives, and radically reduce healthcare spending.

This company has developed a platform called the SMART Health Plan Services System which constantly collects data from employers, health plan members, and providers and uses it to intelligently reduce costs and improve outcomes. Foremost, the company is building 50 proprietary algorithms to predict the onset of chronic disease and major health events. By processing comprehensive data such as pre-adjudicated claims, images, prescription data, and EHR’s, the AI maps the near-term future health state of every health plan member.

The algorithms predict if a member is likely to develop a chronic illness, such as Type 2 Diabetes, or needs a costly procedure, such as knee surgery, and proactively intervenes to drive a member at risk to the most qualified provider so they can take action to avert, reduce, and best manage their health challenge.

The platform also matches members with the most qualified in-network local healthcare providers, ranked in the top 10% for quality, safety, and satisfaction in a specific clinical area. This has proven to reduce ER visits, re-admissions, and unnecessary procedures and drive the best results.

In addition, the AI acts as a personal GPS guide for every member, showing them the best way to achieve their health goals and keeping them on track to do the right things at the right time with the most qualified practitioners. With digital nudges, friendly reminders, inspiring content, and friendly calls, the SMART system anticipates needs and makes it easy for members to stay healthy.

AI is conquering the complexity that stood in the way of reducing costs and producing better outcomes in the healthcare industry. By constantly processing volumes of complex data to yield new insights, learn, predict, anticipate, and adapt, AI helps solve the problems of healthcare past (out of control costs, mystery), meets the demands of healthcare present (value-based care, consumer control) and prepares companies to address the needs of healthcare in the future (personalized medicine). In the end, AI will help us save trillions of dollars -- and more important, millions of lives.

Dan Perkins is an author of both thrillers and children’s books. He appears on over 1,100 radio stations. Mr. Perkins appears regularly on international TV talk shows, he is current events commentator for seven blogs, and a philanthropist with his foundation for American veterans, Songs and Stories for Soldiers, Inc. More information about him, his writings, and other works are available on his website, DanPerkins.guru.