In the last series of posts, I’ve discussed the importance of carefully examining a use case before developing or funding a health AI solution. A use case analysis should include the economic impact of your solution on the business model of the enterprise buying it. In healthcare, most of the sales happens business to business (B2B.) That means the buying organization will do a business case analysis on how investing in a technology solution will impact their bottom line. If you can walk in the door with that analysis done for them and have evidence that your analysis is solid, you’ve improved your chances of adoption dramatically. For my money, I’d want to do this before I write a line of code or develop any AI models. I’d want to know that the customers I’m targeting will see a slam dunk case for buying it.
For example, As reimbursement to providers becomes more value-based, AI can be their secret weapon to perform well on those contracts. AI’s ability to incorporate different data to create better risk models, personalize recommendations for high-risk patients, communicate with patients, generate educational content and learn from its performance over time makes it an ideal tool for value-based contracts. For example, for serious illness care, you can develop models that help you maximize your financial performance.
The figure below shows an example of that. As you can see, depending on whether the patient is in a Fee-for-Service plan, a Medicare Advantage plan or a Shared Saving plan, your AI models can help you to choose the right course of action to optimize your financial performance. This means that instead of the frontline staff having to figure out what is the next best action based on the patients’ insurance and the relevant contract with them (which would never happen!!) the AI models can advise the team. This would happen automatically and without any effort on the part of the staff. A time- and work-saver rather than creating extra work.
As you can see below, depending on the the type of plan the patient has and the program they’re in, the course of action that maximizes the economic benefit to the health system may be to continue to see them in the clinic, or transition to hospice. Certain actions such as HCC coding make more sense in the shared savings plans. All of this is too much to figure out for the frontline staff managing that patient but an AI platform that can take into account various clinical, administrative, and contractual parameters and figure out the next best step.
Carefully analyzing the prospective customers’ cost of ownership, which includes licensing costs plus implementation costs plus maintenance costs, and the benefits, which would include increased revenues (such as the example here) and/or lower expenses (from automation, lower staffing costs, better use of assets, etc) upfront may even allow for designing your system to maximize the business case for the customers. Making certain choices in terms of product features can enhance the odds of adoption.
