Platforms of Intelligence for healthcare providers and payers: The path to personalization and efficient operations

Legacy technologies have slowed innovation in the management of patient care. While medical care and therapies have become more sophisticated, the IT systems that support healthcare haven’t advanced to the same extent. The healthcare industry is being challenged by disparate systems resulting in disjointed processes, increased security risks, and incomplete data records. Today, many healthcare organizations, including our customers, are actively dealing with the challenges of balancing steady-state operations and transformational initiatives.

With the aging segment (>65 years) expected to be ~686 million (11.8% of the total population) by 2023, and health care spending that continues to rise (~6% every year) there is an absolute need for an efficient ecosystem with the ability to consolidate millions of patient records and integrate various healthcare functions, to ensure optimum clinical decision support, patient experience, and value-based care enablement with transparency and lower cost.

ITC Infotech has the domain and data expertise, in addition to strategic tech partnerships, that are critical to healthcare organizations in order to make the transition from traditional to the transformed way of delivering business. We do this through a 4-pronged approach:

a. Technology enablement

The current ISVs have various on-the-fly solutions along with customization options to cater to the Healthcare Industry. Salesforce is one such sophisticated healthcare CRM. It weaves together multiple sources of data such as consumer and patient demographics, psychographics, social, behavioral, clinical, financial, website, call center, and provider credentialing, to provide comprehensive insights and behavior of providers and payers. Salesforce, with a customized vertical Health Cloud and its sales and service modules, enables healthcare organizations to facilitate outstanding care services with a simplified interactive user experience and multi-channel support. It enables intelligent persona-driven profile management coupled with a rich User Experience and a 360-degree view of patients to provide a one-stop shop for schedulers/agents.

b. Enhanced engagement                

i. Patients

In healthcare, providers have been collecting and analyzing data for longer than most industries. To administer the correct treatment, doctors and other medical professionals need to have access to detailed patient history as well as other relevant patient data. As part of the tech transformation, ITC Infotech enables improved communication (both internally and externally with patients), enhanced service, optimized team collaborations, and advanced data analysis. The integrated ecosystem provides an enhanced interface for medical professionals to view patient information and prioritize time-sensitive actions. Agents can also segment patient records for more targeted communication, thereby providing relevant patient experiences at the right moments.

ii. Providers

Engaging with patients on any device and collaborating across the entire healthcare network, from care coordinators to service agents and family members, is an absolute must. A well-implemented solution makes the life of providers easier by enabling access to patient data and creating connects with their patients on all engagements. A 360-degree view of the patient history including care plans, timelines, clinical and nonclinical data records, are made available to physicians in a matter of a few clicks. This ensures providers can deliver patient-centric care while streamlining operations.

iii. Payers

Healthcare payers face a highly competitive market where members and providers expect connected and personalized experiences. As healthcare costs shift to members, payers must respond to the growing demand for better services or risk lower enrolment. In the transformed state, payers will be able to create a 360-degree view of policyholders, making it easier for service and sales representatives to categorize and approach every policy holder uniquely and efficiently. By creating a unified ecosystem, payers will be able to optimize agent workflows, overcome challenges with poor visibility and data tracking, streamline authorization requests with utilization management, and promote collaboration, to achieve business outcomes

c. Artificial Intelligence (AI) and Machine Learning (ML) Driven Full Digital Business Capability (Platforms of Intelligence)

In the current scenario, AI applications using data-driven ML, Deep Learning, and Reinforcement Learning play a crucial role. For example, for providers and payers, AI can provide appropriate training resources, anticipate issues based on patient or member history, and guide call center agents with the right response to an inquiry and next-best-action recommendations. Predictive and prescriptive analytics can identify at-risk populations and recommend next-best actions for timely interventions. Einstein Analytics for Healthcare lets care coordinators, utilization managers, and referral managers gain critical insights and visualize key metrics about their patient populations. Payers and providers can use actionable insights from the app’s dashboards to drive intelligent engagement and improve care effectiveness and efficiency

The Healthcare Industry uses predictive and prescriptive analytics in different ways to improve operations, quality and to minimize risk.  ML has proven to be irreplaceable in identifying risk factors, predicting risk scores, and treatment outcomes. Our ‘Platform of intelligence’ solution leverages the power of data science and scientific algorithms to accelerate and automate the complex analytical use-cases as follows:

A statistical/ML modeling framework for patient no-show and an engagement model is depicted in the figure below. The framework provides a robust view of necessary ML model development life-cycle stages right from defining the business problem, quantifying the same into equivalent analytical form, deep data mining and exploratory data analysis, algorithm selection, model development, validation, monitoring, and production of the model.

d. Success delivered

One of our clients, a leading US-based healthcare provider, had major challenges in managing provider, employees, and patient data across multiple systems and applications. Additionally, low visibility on contact center agents’ productivity and application adoption was affecting the leadership team’s ability to take in-time decisions.

ITC Infotech delivered a unified data model-based Salesforce CRM solution with a personalized experience to solve the problem. The solution was developed with Community cloud and Patient 360 view to improve user experience and patient care services by several degrees. Analytical data-driven decision-making dashboards and reports were used to boost agent efficiency. Salesforce, MDM, and real-time integrations supported synchronized application services and data accuracy. The solution enabled multi-channel capabilities to reduce call waiting and mute time during patient care services.

For healthcare organizations that want an IT partner who can walk the talk to deliver personalized experiences and improved operational efficiency while ensuring competitive advantage, reach out to us  at contact.us@itcinfotech.com

Author:

Praveen Ramachandra
Salesforce – General Manager and Principal Architect, Customer Experience

Avinash Sethi
Lead Consultant, DATA

Lakshmi Repakula
Sr. Project Manager, Customer Experience

Ramapavan. S
Sr. Project Manager, Customer Experience

Karthik Matam
Lead Consultant, Customer Experience