An era of experimentation in digital infrastructure is upon us

COVID may have caused health plans and providers to temporarily hit the brakes on expensive innovation, but experimentation with digital infrastructure looks to be back on the table in the post-pandemic world. 

According to a new report by Bain & Company and KLAS Research, about half of providers and a slightly greater percentage of health plans say they are more or much more willing to experiment with investments now than they were in the pandemic years. 

Most respondents to the survey (75%) said they have already increased their spending on digital tools, including artificial intelligence, with many indicating a significant bump in dollars devoted to infrastructure improvements. 

“Payers and providers are continuing to place a premium on technology, a sentiment that has become increasingly true in the aftermath of the COVID-19 pandemic,” said Eric Berger, partner in Bain & Company’s Healthcare & Life Sciences and Private Equity practice. “While the focus on ROI has increased, we’re also finding these organizations are more inclined to experiment with technology, especially with advanced solutions, such as AI and natural language processing, to improve outcomes.” 

To start with, executives are largely concerned with bulking up their cybersecurity defenses, particularly in the wake of large-scale attacks like the Change Healthcare incident that severely disrupted both care delivery operations and revenue flow. 

More than 60% of providers and payers said they were affected by the attack, and these entities are hyper-focused on auditing their internal operations and current vendors, increasing spending on cybersecurity tools, and building out their professional and managed services relationships. 

Other top priorities on the provider side include clinical workflow optimization, interoperability, revenue cycle management, patient engagement, patient access, and EHR optimization. 

For payers, member care coordination and utilization management are top of mind. Claims processing and payments are also garnering attention, as are issues around risk adjustment, network design, and member care navigation. 

Both providers and payers are eager to dabble in emerging technologies, like generative AI, to solve for these issues. About 70% of providers and 60% of payers are optimistic or highly optimistic about implementing generative AI within their organizations, especially around projects to identify cost-saving opportunities, optimize resource allocation, and enhance member/patient engagement. 

To do so successfully, however, they will need to overcome a series of challenges, including regulatory and legal considerations, resource and staffing constraints, issues of ethics, equity, and accuracy, and cybersecurity concerns. 

Nevertheless, the high degree of optimism and powerful wave of investment indicates that the industry believes these challenges are solvable – and soon enough for them to achieve ROI within a reasonable timeframe. 

Experimentation will be a fundamental factor in this emerging environment, given that generative AI is such a new technology with numerous potential (but as-yet-unproven) use cases across both the payer and provider environments. 

It’s encouraging to see that organizations are willing to take reasonable chances with their investments to produce the evidence necessary to guide future development, and that optimism is the prevailing feeling in the post-COVID world.  As AI proliferates, the industry will need to find the right balance of readiness to try out new strategies and cautious scrutiny of the results to create optimal outcomes from AI-driven care. 

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at jennifer@inklesscreative.com.