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Exponential Improvement from Data, AI, and Digital Technologies

The last post in my new blog series about 2021 healthcare predictions centered on “consumer first thinking.” This week, the attention turns to the exponential improvement in healthcare with data, artificial intelligence (AI), and digital technologies.

The idea of virtual care is not new, but the pandemic has catalyzed the rapid adoption of the virtual care model for care delivery. This shift has created new opportunities to lower the cost of care by combining virtual care delivery models with physical care to improve the care continuum and redirect care to more convenient, higher-value, lower-cost service sites. In addition, patient care is continuing to evolve and become proactive versus reactive. Advancement in data, AI and digital technologies are playing a key role in making all this possible, including a digital front door for care, AI/bot enabled self-services, data interoperability to advance effective delivery of care across the care continuum, and the ability to process and analyze massive amounts of data to detect and alert human interventions before an adverse event or waiting for the consumer to present symptoms.


COVID-19 has also driven a dramatic shift in spending towards modern technologies, such as machine learning, telehealth, and the internet of things (IoT), to deliver consumer-centric care instead of that from payors or providers. Technology-driven innovation (Exhibit 1) may improve our understanding of patients, enable individualized care delivery, and create $350B–$410B in annual value by 2025.(5.1) With more data available, AI and machine learning algorithms coupled with digital technologies will help reinvent care delivery and enable greater speed and insights to predict outcomes that drive better patient care and lower the total cost of care.


Figure 1

Data, AI, and automation to play a bigger role.

Last year was a true inflection point for AI in healthcare, sharply driving up the adoption of chatbots, health screeners, and process automation. The higher acceptance of AI bodes well for organizations involved in pushing the boundaries of automation and analytics and ultimately for the patients and their providers. To be successful in today’s environment, providers must focus on managing both chronic and behavioral health conditions of populations. 75%(5.3) of healthcare costs are tied to patients with chronic conditions. Access to real-time biometric data is critical to predicting acute events for these patients, therefore expect to see more AI-enabled applications processing high volumes of data. Payors will also increase the use of such tools to understand risk better and more accurately set premiums. Payors and providers will be expected to shift their focus on automation from the back office (finance/HR) to the front office, with attended bots working in collaboration with humans. In a recent survey, over 90% of healthcare executives said that improving the clinician experience is a priority for their organizations in 2021.(5.4)


Digital care – the new basis for competition.

Until now, competition in healthcare has been local. Providers primarily competed based on a strong physical presence and perception of brand quality. When the government relaxed regulations to increase flexibility during the pandemic, the new rules significantly decreased telehealth barriers, and providers rapidly adopted this technology to survive and continue their care for patients. Consumers responded equally well by using the virtual platform to receive care. With the rapid adoption of virtual care, the competition will look different in the post-pandemic world. The basis of competition will shift from an overwhelming physical presence to consumer experience and convenience, quality, affordability, and improving population health. As we move forward, advances in technologies like digital, cloud computing, big data platforms, and AI will allow distributed care delivery sites to integrate with digital care. Developments will occur across a consumer-centered ecosystem that improves access to and quality of care while driving avoidable costs out. Virtual and AI-powered care delivery in conjunction with on-site visits will mean fewer on-site staff and less physical space. Hospitals will need to invest in data, AI, and automation technologies – and not on physical presence – to compete in this evolving care delivery model and provide a differentiated consumer experience.


Increase in data interoperability.

In December 2020, CMS announced new interoperability rules that require the electronic exchange of health information between payors, providers, and patients to facilitate better care. This announcement is an excellent step towards sharing patient data to enable healthcare to become consumer-centric, improve the transition of care, and lower the total cost of care. Historically, vendors of Electronic Health Record (EHR) systems have preferred to build closed systems that are marginally interoperable as it benefits them. Providers and payors have thought of patient/member data as their competitive advantage and were unwilling to share this data outside their organization. In addition, the rules on Protected Health Information (PHI) to keep patient data private adds another layer of confusion and complexity in sharing patient/member data safely. One big lesson emerging from the pandemic is that if interoperability was in place, it had the potential of dramatically improving our response to the pandemic and outcomes.


With the proliferation of remote monitoring and wearable devices, the volume of healthcare data is continuing to explode and is expected to grow at 36% CAGR(5.5) through 2025, which is a much faster pace than any other industry. With increasing emphasis on cross-platform (EHR, CRM, virtual health) and cross-organizational data portability, expect to see better data exchange through advanced APIs between various healthcare channels to advance effective delivery of care across the care continuum and reduce waste.



In 2021, we expect that the technological advancements in digital, AI, and machine learning will play a key role in transforming care from reactive to proactive, reinvent care delivery, drive consumer-centric healthcare, and create new competitive advantages for payors and providers alike. Investing in these technologies to improve quality of care, lower cost of care, and create differentiated services will be critical in sustaining your organization.


Do you think you know what my last prediction for 2021 will be? Check back next week and see if you’re right (or download the full report and settle it right now)!



5.1 McKinsey Era of Exponential Improvement report, May 2019
5.2 Deloitte Health Tech Investment Report, Mar 2020
5.3 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5876976/
5.4 PWC Top Health Industry Issues 2021
5.5 https://www.rbccm.com/en/gib/healthcare/episode/the_healthcare_data_explosion



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