There’s an immense amount of discussion these days about how AI is changing the world, and about how it could transform healthcare, in particular. There are applications of AI in almost every aspect of healthcare, but the one I want to focus on here is related to what is generally referred to as Care Management.
One of the things that is particularly appealing about the application of AI in Care Management is that its ability to augment and ultimately replace some healthcare workers while improving care and reducing costs is a good thing due to growing workforce shortages in the sector, whereas in other sectors of our economy the potential impact of AI on employment is less welcome.
Workforce Shortages are Growing
In my previous blogs and newsletters, we have discussed the growing physician shortage in the U.S. (up to an estimated 86,000 by 2036 according to the latest projections by the American Association of Medical Colleges), as well as the already acute and growing shortage of other healthcare workers. I won’t repeat the many reasons for this, including pandemic-related burnout, but the current and looming shortages are very real, and this is a global phenomenon. A recent report from the World Health Organization projected a worldwide shortage of 10 million healthcare workers by 2030, and workforce issues are now the #1 concern of U.S. healthcare executives.
The shortage of healthcare workers not only causes a reduction in the availability of critical services, but it is also putting additional pressure on the healthcare workers who have remained in the system, thus increasing burnout and accelerating further attrition. In addition, the cost of many healthcare workers has effectively been reset at rates that are an average of 30% higher than pre-pandemic levels, which puts pressure on provider margins and ultimately leads to higher costs in a system that is already unsustainable at an annual cost in the U.S. of $4.5 trillion – and that’s before the full effects of an aging population and continued advances in expensive new therapies have been factored in.
Care Management Basics
One of the strategies that third-party payors and providers have used with some success to improve outcomes and control costs is generally referred to as Care Management. An important part of Care Management is what happens (or should happen) between provider visits, particularly for the large population of patients who have one or more chronic conditions or who are at risk of developing them. These are the patients who suffer the most from morbidity and are at the highest risk of mortality, and they are the costliest. Patients with multiple chronic conditions are sometimes referred to as the 5/50s – the 5% of the patients who generate 50% of healthcare costs.
These high-risk patients and others who are trending in this direction (as well as patients who are recovering from surgeries) need constant monitoring and coaching in areas including education on their conditions, medication adherence, diet and nutrition, emotional health, transportation, and care coordination to improve the quality of their lives and minimize the need for expensive and frequently debilitating medical interventions. However, even if they are fortunate enough to have primary care physicians who see them on a regular basis, the limited frequency and duration of these visits is not nearly enough to effectively address their ongoing health issues.
Enter the Care Coach, who in the past (when I was the CEO of a Care Management company called Health Dialog) typically was a highly trained registered nurse who interacted with a panel of patients between provider visits in an effort to ensure that each patient was making the right health choices and was getting the support they needed to effectively manage their conditions. Historically, these interactions were primarily telephonic, with ancillary support from print and video materials, and more recently via asynchronous text and email.
AI-Powered Care Coaches Will Be Transformational
While Care Management programs funded by health insurers and risk-bearing providers have generally produced positive ROIs, their significant up-front expense has been a barrier to full deployment, and telephonic engagement has become increasingly challenging due to individuals’ increasing reluctance to respond to calls from unknown parties. And, as you would expect, the growing shortage of nurses and other healthcare workers – and their increased cost – has reduced the clinical effectiveness and financial viability of traditionally delivered Care Management.
But what if every needy patient could have an AI-powered health coach who is interacting with them on a daily basis and available to them 24/7 via text or interactive video, is able to interact seamlessly with other members of the care team (the patient’s primary care providers, specialists, pharmacists, etc.) as necessary, and can cost a fraction of what a real nurse coach costs today (assuming they were available)? These AI-powered care coaches already exist and are being deployed primarily in pilot programs. They work by ingesting and analyzing vast amounts of healthcare data – including clinical care plans, regulatory documents, medical manuals, and drug databases—and use AI algorithms to respond in highly individualized ways to each patients’ health needs.
In some cases, these digital health coaches are supporting live nurse coaches in ways that substantially increase their productivity, and in other cases they are operating independently (always in non-diagnostic capacities). The early documented results are promising in terms of medical accuracy and both patient and provider engagement and satisfaction, and at a significantly lower cost than previous Care Management models.
It will take time for AI-powered care coaches to become fully “trained,” and for patients to become accustomed to them and trust them, but they have the potential to help to save healthcare by filling critical gaps caused by growing workforce shortages while improving care and reducing costs.