The biggest problem the United States healthcare system faces is preventable disease. We don’t have enough doctors, nurses, and health coaches to fix it. Yes, we have a doctor and nurse shortage. But the larger issue is that the treatment or prevention of these types of diseases requires significant behavior and lifestyle changes, which are achieved through extensive coaching, carefully timed intervention, and constant monitoring – all very hands-on, human activities. Even the best, most attentive healthcare providers simply can’t be there for a patient around the clock to catch every bad habit or reinforce every positive behavior.
Many make the argument that we need to increase federal funds and train more nurses, license more physicians, and/or deploy more health coaches. Yes, we need to do these things, but it’s not going to be enough, and increasingly people are becoming more comfortable interacting with machines than they are with humans. Traditional approaches, even if they are wildly successful, only ensure that more people get to see their doctor in a timely fashion. They don’t do anything to help doctors spend more time with each patient. It’s time to turn to technology to help us do what it does best – scale.
Artificial Intelligence (AI) has evolved to the point that it can significantly augment the work done by physicians, pharmacists, and health coaches. AI-powered technologies can fill in the gaps between appointments by reminding patients to take their medications according to their schedule, influencing and rewarding behavior change at exactly the right moment, and even intervening when something in the treatment plan is off. AI is capable of learning and growing with a patient too, so it can adapt and adjust based on the patient’s individual needs, schedule, and disease.
The preventable disease problem we’re facing in healthcare today can be solved by a deepening relationship between humans and AI.
If this sounds futuristic, it is… sort of. The technology already exists and is deployed in other arenas like finance and business intelligence. But in healthcare, there’s a human and psychological barrier – can we trust AI with our health? Our health data?
In a recent study conducted by Next IT Healthcare and Kaiser Permanente, researchers found that patients are increasingly comfortable with and trusting of AI-driven virtual health coaches. In fact, many patients who interacted with artificial intelligence-driven technology in a doctor’s office were inclined to disclose more information than they would otherwise tell their doctors.
What does this new human-to-machine bond make possible for our healthcare system? The implications for healthcare are profound.
Better data. When patients interact with a virtual health coach on their phone, desktop or tablet, human caregivers get new context that has heretofore been very difficult to obtain, particularly in real-time. Virtual health coaches are perhaps the best collection mechanism for data addressing patient medication questions, treatment plan adherence, and accessing how patients are feeling day to day. Consider what happens when we can correlate this data with other patient-generated data, like that from wearables, home monitors, scales, and environmental sensors.
Healthcare providers can use this data to better understand when to intervene, to predict and prevent relapses, and to create a custom treatment plan specific to a patient’s routine that also evolves with the patient. The value of high-fidelity and real-time patient generated data is immense and will be transformative.
System-wide cost benefits. 24/7 access to what is essentially a nurse-less hotline can reduce the burden on doctors and other care providers. They can ensure that when human interactions are needed, they are as impactful as possible.
Imagine a patient needs help understanding the side effects of a drug she is taking. A virtual health coach can walk a patient through the known side effects and identify if the patient is experiencing any of those effects. If she is, the virtual health coach can determine the severity of the side effects by asking a series of questions. The technology can then triage and rout the resulting information to a live healthcare provider, who can intervene immediately if needed, and help the patient determine if she needs a trip to the emergency room, or can treat the symptoms at home.
Early detection prevents potentially costly complications while patients would otherwise be waiting for an office visit. But the technology can also reduce the occurrence of unnecessary office visits. Whether there’s a problem or not, this technology can drive efficiency.
Personalized treatment. “Doctor’s orders,” treatment plans and standards of care are rooted in sound science and studies involving hundreds and thousands of subjects, but are rarely tailored to the individual – eat vegetables 3-4 times a day, exercise 3-5 days a week, take your pills twice a day for 2 weeks. Yet adherence to these kinds of recommendations is dismal because there is no guidance on how a patient can achieve those goals and why, particularly given their existing lifestyle and behaviors.
A virtual health assistant is able to spend more time with patients than even the best and most attentive healthcare providers, and using motivational interviewing it can collect valuable information and insights passively and proactively. It can therefore learn a patient’s preferences, habits, and routines, and adapt treatment plans to match.
For example, instead of prescribing a medication and saying a patient needs to take it twice a day, 12 hours apart with food, a virtual health coach can learn when you generally eat breakfast and dinner, and when you wake up and go to bed and help you determine a specific schedule that fits your lifestyle and improves the outcome.
Regulation & Policy Implications
The human benefits that virtual health assistants can bestow on the patient population are clear. But are there relevant policy issues that VHAs can help address too? First it should come as no surprise that the debate around healthcare has centered on its fiscal impact. For example:
- According to the Centers for Disease Control and Prevention, the World Health Organization has estimated that by 2020 the number of Americans affected by at least one chronic condition requiring medication therapy will grow to 157 million. Additionally, the direct economic cost associated with non-adherence to medication is estimated at $100 billion to $289 billion.
- Chronic diseases are responsible for 7 of 10 deaths each year, and treating people with chronic disease accounts for 86% of our nation’s healthcare costs.
- From 2015-2025, health spending is projected to grow at an average rate of 5.8% per year and will grow 1.3 percentage points faster than the Gross Domestic Product per year over this period.
Only recently have policymakers begun to examine the benefits of how integrating healthcare professional services can create an improved outlook on cost containment and patient outcomes.
Prior to the enactment of the Affordable Care Act (ACA), patients would receive siloed treatment as there would be no coordination of care for a patient that transitioned from acute to post-acute care settings. It is during this vital time that patient questions go unanswered and the risk of non-adherence rises thus driving up healthcare cost. However; to tackle this problem, the ACA has created alternative payment models such as bundled payments that are forcing providers to share more risks in an effort to receive a greater piece of now “shared” reimbursement. Now providers must work together to demonstrate how they have affected a patient’s positive outcome and thus created value for the healthcare system. The best way to do this is through data sharing. That is one area where virtual health coaches have the greatest opportunity.
The origins of data sharing as a way to tame healthcare spending can be seen through the enactment of the Health Information Technology for Economic and Clinical Health (HITECH) Act. The law’s enactment in 2009 along with the solidification of the importance of electronic health records in the ACA, set the stage for physicians and hospital providers to receive a reimbursement incentive from the Centers for Medicare and Medicaid Services (CMS) for those who are successful in becoming “meaningful users” of electronic health records. If providers have not found a way to do this by 2015, they would soon find themselves subjected to penalties under Medicare.
As providers continue to struggle with how to implement electronic health records into their practices, perhaps they are overlooking the simplicity of AI-powered solutions. More than ever consumers are becoming more involved with maintaining a healthy lifestyle using technology such as fitness apps and telehealth. Interestingly, about 35% of U.S. adults say they have used the Internet to figure out what medical condition they or someone else might have, demonstrating a need for on-demand convenience. Utilizing a virtual health coach can not only give healthcare providers a better look into what works for a patient, but also satisfies policymaker goals. First, healthcare costs can be reduced since a virtual health coach serves as another powerful tool a provider can use in monitoring a patient; records created by the VHA could be shown by the provider community that they are meeting the “meaningful use” requirements set the by HITECH Act, and by putting patients in control of their own outcomes by utilizing a tool that can adapt to their lifestyle would more likely than not create a potent recipe for cost containment success.
Integrating AI into everyday chronic disease management has the potential to solve some of the most burdensome problems facing the U.S. healthcare system. AI-powered solutions improve engagement with patients, earn their trust in the process, and offer a comprehensive holistic one-stop-shop ecosystem from which the patient can manage their health, something the previous generation of health technologies could not accomplish. The human-to-machine bond makes it possible for this new generation of technologies to directly address rising costs while improving quality of life and patient outcomes.
Though we’re still in the early stages, and we certainly don’t have all of the answers, we need to pursue this area of innovation with urgency. Imagine a healthcare system aided by artificial intelligence that is a trusted partner in a patient’s lifelong healthcare journey.
That day, we believe, is just around the corner. Contact us for more information.