AI Solutions for Healthcare

By Patrick Stamm, Advisor at Codoxo and Former COO of Shared Services at UnitedHealthCare and Musheer Ahmed, CEO & Founder, Codoxo

COVID-19 has changed healthcare: It’s changed how patients in the United States access their healthcare, it’s changed what they are being treated for, it’s changed their behaviors on receiving care and more. Because of all of these shifts, Americans will likely see an increase in healthcare costs, to the tune of 6.5% in 2022 alone.

When it comes to the growing inflators of healthcare costs today, COVID-19 is the big elephant in the room. It is driving costs up now and will continue to keep costs high in the near future.

The increased popularity of telehealth 

Virtual care options are on the rise, dramatically changing the healthcare landscape. An astounding 77% of clinicians say that new, nontraditional care venues like on-demand telehealth either are maintaining or improving health outcomes.

And while the benefits are clear, there are also some potential areas to watch. Virtual health visits come with a lower cost to deliver care and are presumably quite efficient. Research confirms that patients like this care delivery model and are comfortable with virtual care going forward. For these reasons, we know virtual care is here to stay for the long haul. This reality requires us to better articulate and understand the payment and medical policies around virtual care.

When it comes to telehealth, we need to make sure that:

    • The right services are covered
    • Accreditations are correct and appropriate
    • We have the capability to review claims effectively
    • We develop new programs to address potential gaps
    • We have the right review and investigative resources
The effects and prolonged care of those with COVID-19 

Aside from telehealth, there are many people still dealing with symptoms of COVID-19 – 10 to 30% of COVID survivors develop long COVID, and it’s interesting to note that more than 75% of long COVID patients were not hospitalized for their initial COVID-19 illness. It will be critical for the industry to develop a better understanding of the acceptable treatments and associated payment policies to improve outcomes and manage costs.

How to confidently move forward in our new normal 

Aside from telehealth, there are many people still dealing with symptoms of COVID-19 – 10 to 30% of COVID survivors develop long COVID, and it’s interesting to note that more than 75% of long COVID patients were not hospitalized for their initial COVID-19 illness. It will be critical for the industry to develop a better understanding of the acceptable treatments and associated payment policies to improve outcomes and manage costs.

As we venture through 2022 and beyond, healthcare providers have their work cut out for them. They need to keep an eye on the shifting impacts of COVID on healthcare costs, quality and care delivery, as well as the critical role of telehealth. Healthcare leaders will need savvy approaches to proactively and effectively mitigate costs and should evaluate the benefits of advanced analytics, automation, AI/ML and other technologies. These investments have proven to be effective and help healthcare organizations stay ahead of rising costs and identify bad actors more quickly.

Patrick Stamm was a panelist at Codoxo’s Healthcare Executive Round Table, “Re-envisioning Healthcare In 2022 and Beyond,” along with other industry leaders. To watch, click here. To read our eBook, click here.

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