Key Takeaways from Modern Healthcare’s Digital Innovation Summit

I spent last Tuesday at the Modern Healthcare Digital Innovation Summit, where a number of colleagues and I engaged with leaders from health systems, payers, and digital health organizations. The discussions and speaking sessions were rich with insights on the current state and future direction of healthcare innovation. Here are some common themes that emerged.

Tech Innovation vs. Ecosystem Transformation

A significant portion of the conversation focused on the transformational potential of AI. Technology alone won’t necessarily change the broader business environment and incentives. As Microsoft Health Senior VP Dr. James Weinstein aptly stated, “The system produces the results it’s designed to produce.”

For instance, while we have long possessed the technology to break down data silos between different health systems, interoperability remains a huge hurdle for many. Sharing data between health systems, especially those with different EMRs, remains challenging. AI promises substantial process improvements by reducing the cost of retrieving information, but its impact will be limited by the current incentive structures.

However it can make processes within that system much more efficient. I was recently catching up with a head of revenue cycle at a health system. Previously they had coders review clinical notes to ensure that claims contained the right diagnostic and CPT codes before submitting to payers for reimbursement. Now, they are able to deploy LLMs against those clinical notes to extract the right data and then use a rules engine to complete the claims, incorporating each payers’ specific rules.

AI is Only as Good as the Data it is Supported By

Sara Vaezy, Chief Strategy and Digital Officer at Providence, shared impressive advancements in managing patient messages. Providence handles 700,000 patient messages per month across 25,000 physicians. An LLM (large language model) now reads these messages to understand their intent and provides a potential resolution before forwarding them to a physician if necessary. This innovation has reduced incoming messages to providers by 23%.

For the messages that do reach physicians, the system compiles all relevant information needed for a response, accelerating the process. This approach significantly reduces physician “pajama” time, with substantial anecdotal support from the medical staff.

Sara emphasized that the effectiveness of these AI solutions hinges on their connection to comprehensive data sources, including patient medical records, past interactions, scheduling systems, and billing information. Providence’s success in leveraging LLMs is a testament to the importance of building robust data infrastructures, an area where 3Pillar excels. Learn more about our foundational AI work here.

Navigating the Technology Complexity Paradox

As Glenn Tillman, CEO of Transcarent, pointed out, while technology simplifies processes, it can also introduce greater complexity. For example, the medical billing system, with its 600,000 CPT codes and intricate benefit rules, exists because of technological advancements. Ideally, these complexities should enable more personalized insurance products.

However, the challenge lies in simplifying this complexity for the end user. Many designers strive to create intuitive workflows, but no product can seamlessly account for every detail in a 150-page medical policy. AI plays a crucial role here by quickly synthesizing data and providing clear, direct answers to user inquiries.

RCM and Claims is an area where this is especially true (and where 3Pillar does substantial work for our healthcare clients). The reimbursement landscape was designed when plans with copays were the norm. The messy interactions between providers and payers happened in the background.

However, with high deductible plans the new normal, patients are exposed to antiquated systems that leave them wondering how much a given procedure will cost them until weeks or months afterwards. Payers have introduced tools to give members an anticipated cost for a given CPT code, but these tools don’t capture the nuanced medical policies contained in 100+ page PDFs that have a real impact on whether that CPT code will even be covered.

This is an area 3Pillar is exploring with health plan clients. Looking to take the negotiated rates with a particular provider and combine that with a chatbot that can synthesize the particular plan’s medical policies to answer – in real time – the members’ financial anxiety around cost when their clinician proposes next steps.

Smaller Takeaways

Administrative Prioritization for AI

Rohit Chandra, Chief Digital Officer at Cleveland Clinic, highlighted that while providers are cautious about incorporating AI into clinical pathways, there is a strong push to leverage AI for administrative tasks. Explaining benefits, streamlining workflows, and optimizing clinician staffing are areas ripe for AI-driven improvements, presenting immediate opportunities for health systems.

Payer Innovation

Pete Serio, Chief Customer Officer at Florida Blue, is pioneering ways for payers to enhance member experiences. By ensuring consistency in patient interactions across all channels (mail, phone, web, app), they are connecting underlying data systems to enable AI-driven intelligence. Additionally, they are working on integrating plan rules into the point-of-care process to inform care plans in real-time, reducing the delays and frustrations associated with prior authorizations.

Of course, many health plans are held back from this type of innovation by particularly antiquated tech stacks. Helping payers modernize their underlying data and platform architecture is a primary focus of our work.

Setting Expectations Around AI Chatbots

Alya Sulaiman, a partner at McDermott Will & Emery LLP, stressed the importance of managing patient expectations when using AI chatbots. It’s crucial to be upfront about what the chatbot can and cannot do, and to establish clear escalation paths to human agents for complex issues.

Hospital at Home

Deborah DiSanzo concluded the summit with an inspiring talk on how Best Buy is facilitating the transition to Hospital at Home models. Their collaboration with Geisinger was showcased in an impactful video, highlighting innovative approaches to home-based care.

The Future of Healthcare

The discussions at the Modern Healthcare Digital Innovation Summit underscored the value of the work we do at 3Pillar. The leaders at this conference understand how to identify and evaluate opportunities to improve care. What they need is support in executing these innovations—designing and building new workflows, updating applications, and creating data architectures that generate actionable insights. We’re excited to continue partnering with them to drive meaningful change in healthcare.

Interested in finding out more about how we’re helping healthcare organizations improve the patient experience and rethink their approach to technology? See some of our latest case studies and blog posts on our Healthcare page. And don’t hesitate to reach out to me via email at steve.rowe@3pillarglobal.com. I love nothing more than helping healthcare companies solve some of their most pressing challenges through innovative applications of technology.

About Steve Rowe

Steve Rowe is the Industry Leader for the Healthcare Portfolio at 3Pillar Global. He brings 15 years of experience launching new healthcare products with health systems, payers, distributors, retailers and pharmaceuticals. He intimately understands the business of healthcare. At 3Pillar he partners with clients to identify the product and technical work that will deliver the strongest value.

Prior to working at 3Pillar, Steve worked in digital health directly and led product strategy at GetWellNetwork. He also launched his own company providing price transparency and POS collection tools for urgent care chains. He most recently led strategy at BCBS of Kansas City.

Steve holds a BA from Hamilton College. He lives in Denver, Colorado with his wife and two sons (both under 5, have mercy on him). Outside of work and child-rearing, you’ll find him skiing, hiking, and pretending he’s competitive in triathlons.