Embracing AI in healthcare: A balance of innovation and compliance
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It’s Annual Enrollment season for employers. This fall, millions of people are taking advantage of the insurance coverage provided by their employers to select benefits. Employees pore over their options – what’s the monthly premium? How high is my deductible? Are my doctors in network? At this time of year, every HR professional and benefits manager is asking themselves, “Have I done everything I can to provide employees with the healthcare they deserve?”
I am fortunate this week to spend time at the Reuters Workforce Conference with 150+ HR executives in Chicago. The timing couldn’t be better. Healthcare is top of mind because carefully negotiated medical and pharmacy benefits, digital health solutions, and myriad other offerings have just been presented to employees.
In a perfect world, every benefits plan design would be, well, perfect. Employers would never fail to offer the best benefits, knowing their employees would receive world-class care, tightly integrated and coordinated across all providers and medical events. As we are aware, the world we live in is far from perfect – or even passable. Instead, companies today execute directly into the headwind of a broken healthcare system. Their best laid plans run headlong into an industry that seems designed to frustrate, confuse, and even bankrupt.
It doesn’t have to be this way. Medicine today is amazing. We routinely cure diseases, reverse diabetes, address health equity. The healthcare system is the problem. The solution is out there. So how do we fix it?
It sounds almost simplistic. What’s needed is more access to high-quality, longitudinal care that maximizes access to primary care and behavioral health professionals. Less time waiting for care. And for the providers involved to have the data required to deliver long-term, longitudinal care that treats the whole patient, and not the individual ailments they are facing. All of that, delivered by people who genuinely care for your employees and their wellbeing. It is possible.
We start by embracing reality, and then we knuckle down for hard work. A yawning Physician Gap plagues healthcare, and it interferes with any attempt at progress. We have to focus on the right action. Several of the right actions are being addressed by leaders in our space right now:
Improving access to primary care and mental health physicians, as well as extending their accessibility and capabilities with rich, experienced front line care teams available 24/7.
Arming physicians with the data to understand the longitudinal needs of each patient – their every medication, every doctor they see, every condition they battle. We have to recognize that a lack of data leads to poor diagnosis, overuse of specialists, urgent care and emergency room misuse, and a negative experience for everyone.
Eliminating the discrimination caused by inherent inequities in our system. Only through true population health strategies, that objectively stratify populations and guide individuals to the best resources, can we begin to improve the healthcare experience for all employees and their families, not just the fortunate or well-connected.
Let’s recognize that no one company can fix this problem on their own. Only by embracing the broader healthcare ecosystem can we begin to build solutions that are stronger together.
More tactically, there are three things Accolade is focused on today.
For a very long time, advocacy has existed to guide members from point to point in an otherwise overwhelming environment. These services boldly approach solving the intractable problem of a broken healthcare system with caring guidance – and it works to a certain extent. Noble, knowledgeable, hardworking people doing the right thing on behalf of someone who needs their help. Who wouldn’t want a lionhearted champion?
But no solution – human or technology – can make an appointment for a member if the appointment doesn’t exist. Physician-led advocacy entails placing the member-physician relationship at the center of every interaction and ensures that this relationship remains sound longitudinally. For every member. Regardless of whether they are low, medium, or high risk. Importantly, physician-led advocacy works hand in hand with the brick-and-mortar healthcare system on the ground – seamlessly sharing data and ensuring the longitudinal journey for the member is never interrupted.
Some companies want you to believe that AI and software will eliminate the need for human care teams and advocates. They cast aside those passionate champions as “middlemen” getting in the way and believe blindly in AI’s ability to treat and cure people. Others say that all you need is a dedicated team of zealous healthcare advocates. Both extremes are wrong, as extremes tend to be, and are, frankly, patronizing to smart consumers.
The way forward embraces technology and leverages its power where it materially improves healthcare experiences. At the same time, we must recognize that taking human connection out of the healthcare journey would have disastrous results for utilization and outcomes because care is inherently personal. It’s about your life. Your most personal and private decisions. And that of your family. The best solutions obsess over the member experience and deliver the right options, at the right time, through the right medium. At Accolade, we use AI to help optimal front line care team members address people quickly, and understand our members’ risk profiles. And we use it to help physicians access the data they need to recommend the most appropriate care journey. We use technology to make our care teams better, not to replace them.
In a space this complex, we cannot work alone. The depth of specialization required to execute on being truly member-obsessed increases significantly as stakes climb. Take for example polychronic cases where the member struggles with multiple issues. Each condition deserves the highest quality, focused specialization, even if that means a wide range of providers and condition-specific solutions, such as Virta for diabetes, Lyra for mental health, or Sword Health for physical therapy. But it also requires careful data continuity between all of these health episodes.
The topical issue dominating the headlines today is weight loss and GLP-1 drugs. A clinically rigorous program involves a person’s PCP, mental health therapy, behavioral coaching, pharmaceutical advice, and billing support. The entire care journey is stronger when all these specialties work closely together for the benefit of the consumer, getting to the right outcomes, and keeping the primary care physician in the loop.
It’s time for those who care about the Physician Gap to recognize our collective strength. If we choose to embrace reality, and fearlessly, relentlessly execute on a patient-obsessed vision for better care, we will deliver the healthcare system Americans deserve. It’s time to close the Physician Gap. To paraphrase Marc Andreessen, we must choose to build a better healthcare system because collectively we want healthy people more than we want other things.