Pager Health, a virtual care navigation platform, is making waves in the healthcare technology sector with its recent unveiling of three new AI tools designed to transform payer operations. Developed in collaboration with Google Cloud, these tools leverage cutting-edge generative AI technology to automate administrative tasks and enhance member interactions, promising a future of streamlined efficiency for the payer industry.
The centerpiece of this AI suite is the chat summation tool. This innovative solution tackles the time-consuming burden of post-encounter documentation for clinicians. Traditionally, summarizing member interactions could eat up a significant portion of a clinician’s time, often taking 10-15 minutes. As Nick D’Addezio, Pager’s vice president of strategy and business development, highlights, the US healthcare system faces a stark reality – one million doctors serving over 300 million people. By automating the summarization process and reducing documentation time to a mere minute, the chat summation tool frees up valuable clinician time for more patient-centric activities. In a healthcare landscape grappling with workforce shortages, such a solution offers immense value.
However, the potential for increased efficiency through AI automation raises concerns about job security within the payer industry. The automation of administrative tasks might be perceived as justification for staff reductions. D’Addezio acknowledges this apprehension, emphasizing that the goal isn’t staff elimination, but rather empowering existing staff with “superpowers” to enhance their capabilities.
Another key component of Pager’s AI arsenal is the frequently asked questions (FAQ) bot. Built on Google Dialogflow, this intelligent bot streamlines call center operations by deflecting routine health and benefit inquiries. By providing readily available answers to common questions, the FAQ bot frees up call center agents to handle more complex member interactions, requiring a higher level of human expertise.
Finally, the sentiment analysis tool, powered by Google Vertex AI, delves deeper into member interactions. This innovative tool analyzes a member’s emotional state during an interaction by evaluating factors like word choice, tone, and response speed. By identifying signs of frustration or anxiety, the sentiment analysis tool equips payers with valuable data to optimize member interactions and enhance call center training. Additionally, D’Addezio envisions a future where similar tools might suggest appropriate responses within the platform, further enhancing communication efficiency.
Pager’s strategic partnership with Google Cloud provides a crucial foundation for these AI advancements. As one of Google Cloud’s 40 healthcare-focused independent software vendors (ISVs), Pager leverages Google’s expertise in AI technology. Notably, Pager prioritizes data security. Unlike some AI platforms that pool all data into one central dataset, Google’s technology allows Pager to tailor models to specific client datasets, alleviating concerns about data leakage and ensuring client confidentiality.
Currently, Pager primarily partners with 10 Blue Cross Blue Shield plans and major Latin American insurers. However, the company is actively seeking partnerships with national plans, suggesting a potential for wider industry adoption of these AI tools.
The potential impact of these administrative streamlining tools is significant. Payers, constantly striving for greater efficiency and cost savings, undoubtedly see value in optimizing operations. However, the human resources impact can’t be ignored. D’Addezio acknowledges the historical approach within the industry of using cost savings in medical care to justify reductions in administrative expenses. Here, the focus shifts to “supercharging” the capabilities of existing staff, empowering them to manage patient interactions more effectively.
The success of this approach hinges on a delicate balance. Payers must leverage AI tools to optimize operations without sacrificing workforce morale. The industry must navigate a path towards efficiency that empowers employees rather than replacing them. After all, human interaction remains a cornerstone of quality healthcare delivery.
The coming years will be crucial in determining the long-term impact of Pager’s AI solutions. While the potential for streamlining operations and improving member engagement is undeniable, the question remains: will AI empower the payer workforce or simply become a catalyst for workforce reduction? Only time will tell if these AI tools truly represent a revolution in efficiency or a potential disruption for payer employees.