2022 is shaping up to be a transformative year for the healthcare sector. Health plans, payers, and providers must all navigate new regulations, societal shifts, and technological advances.
- The aftereffects of the COVID-19 pandemic have brought changes in consumer preferences and habits.
- The No Surprises Act has ushered in a host of new consumer protections and requirements for healthcare organizations.
- Artificial intelligence continues to proliferate in healthcare.
The healthcare payment field is just as poised for innovation, disruption, and change as the rest of the healthcare field. Let’s look at what 2022 likely has in store for the healthcare industry.
Digitally Driving Patient Loyalty
Patients care about more than just their relationship with their doctors or the quality of their care. The overall patient experience makes a big difference in patient loyalty to their healthcare providers. Consumers often report payments and billing as significant pain points in their experiences. A third of patients report they would switch providers if faced with a difficult payment process.
Patients report three primary pain points regarding the healthcare payment experience, whether they are self-pay or health plan members.
- Poor transparency
- Lack of compassion
Artificial Intelligence is continuing to revolutionize healthcare, not just in diagnosis and treatment but also in the patient experience. This should only accelerate in 2022.
110 million Americans switched to preferring digital-first payments last year. While many of them were motivated to do so by the pandemic, digital-first means less paperwork and often less hassle. 83.2% of those Americans plan on continuing to rely on digital-first shopping and payments in the future.
Modern consumers expect that level of convenience. Providing it not only improves patient satisfaction, but it also improves revenues and collections for many providers as well. Many new solutions offer not only contactless, digital-first payment options, but emerging AI technologies that offer customized billing and financing options, reducing administrative workload and increasing the collection rate. Fewer unpaid bills, happier customers, and lower overhead are powerful motivations for providers to adopt digital-first payment in 2022 and beyond.
Prompts And Reminders
Emerging AI technologies like automation and machine learning allow the patient experience to be further customized with individualized prompts, reminders, and other automated patient support mechanisms. With vast data available on each patient, providers can understand a patient’s financial situation and billing preferences. They can then reach out with prompts and financing options at the optimum times and through their preferred channels, whether that be text messaging, a voice call, or an email. The same functionality can even set expectations before services are rendered through delivering estimates. This not only improves revenue for providers, it provides support for patients.
Back-End Automation: Improving Efficiencies For Health Plans
AI, combined with social trends, will make big changes in healthcare payments on the patient-facing side of healthcare this year. However, automation will also continue to make big changes to payments from a back office perspective.
The sheer volume of data produced in healthcare makes manual processing, reporting, and functions like fraud prevention or reconciliation increasingly difficult, especially as this data increases exponentially each year. Use of emerging AI technologies to automate data-driven tasks is a must for health plans and other healthcare payers. These advances allow payers to efficiently process payments, detect fraud, waste, and abuse charges, and service plan members’ needs across multiple channels in a timely fashion.
Facing the enormous effort to stand up AI capabilities on their own, many healthcare organizations are choosing to partner with vendors offering already established capabilities and subject matter expertise. For example, Alaffia Health uses machine learning, automation, and other AI technology to conduct initial reviews of high-cost claims for fraud, waste, and abuse charges. This helps healthcare payers prevent medical overpayments. Alaffia’s payment integrity analysts then review claims flagged by the initial AI review, using their subject matter expertise to ferret out expensive overcharges.
Artificial intelligence can sift through massive quantities of data quickly and flag claims likely to contain fraud, waste, and abuse charges. This allows Alaffia’s analysts to review more claims and identify more overpayments.
These technologies are expensive and time-consuming to develop, but one trend we expect to see more of in 2022 is health plans and other payers partnering with vendors such as Alaffia for scalable expertise in areas of specialized need.
Telehealth: Bringing Care To The Patient
Telehealth became a necessity for many in 2020. Many areas suffered repeated lockdowns and healthcare providers struggled to handle the pandemic caseload. One study showed telehealth Medicare visits increased 63-fold in 2020 as COVID restrictions forced providers and patients to rely on telehealth in many situations. A return to relative normalcy has led to a reopening of doctor’s offices for on-site care, but telehealth adoption rates remain 38 times higher than they were before the pandemic.
Government regulations regarding telehealth were loosened due to the pandemic, and experts expect that to become the new normal going forward. Telehealth offers many benefits for elderly and homebound patients, or patients with transportation challenges, to access care.
Telehealth allows providers to see more patients and patients to access care more easily, but it comes with its own challenges. Medical billing and coding is already an infinitely complex endeavor, and telehealth services add another set of codes and procedures into the mix, increasing chances for human error or fraudulent charges. While the benefits are well worth the challenges, the continuing rise of telehealth is another driver for healthcare payers to partner with payment integrity specialists such as Alaffia in 2022 and beyond.
AI Technology In 2022 and Beyond
AI has dominated healthcare advancement for years, and for good reason. The field is advancing quickly, illuminating new ways to leverage these technologies. There's enormous potential for diagnosis, treatment, administrative tasks, and improving the patient experience.
AI is no panacea. Healthcare executives are recognizing that AI functions best when thoughtfully implemented as a force multiplier for human staff. One common thread in our 2022 predictions is that AI’s continuing growth in healthcare will largely be driven by the fusion of AI efficiency and human expertise and insight. AI technology has massive potential, but only when you take its limitations into account. AI doesn’t replace human intelligence; it works best when it supplements human intelligence.
How can your organization leverage these advances? A great starting point is with payment integrity! An estimated 80% of healthcare claims contain at least one overcharge. Alaffia Health’s AI platform integrates seamlessly with your systems to prevent many of these overpayments. This provides an immediate positive impact on your bottom line.
2022 may be one of the most disruptive years yet for the modern healthcare industry. Don’t get left behind. We can help you prevent overpayments and leverage AI for the benefit of your health plan members. Learn more today!