Navigating healthcare challenges with AI

In a recent interview, Peyman Zand, Chief Strategy Officer at CereCore, probed the complex landscape of healthcare in the United States, shedding light on challenges, opportunities, and the transformative potential of artificial intelligence (AI). 

Challenges in Achieving Value-Based Care

“I think the value based care model in the US has been difficult, obviously,” Zand began. “They haven’t been able to move the needle.” 

Value-based care has been a significant topic of discussion in the U.S. healthcare system, and Zand acknowledges the difficulties in its implementation. He identifies two major entities with the potential to drive this transition – Medicaid and Medicare organizations under CMS (Centers for Medicare & Medicaid Services) and payer organizations. These entities are gradually moving towards payment structures that align with value-based care principles. However, the transition is far from simple, as traditional hospitals often struggle to adapt due to higher cost structures. 

Zand highlights a fundamental challenge: “If you’re only getting paid $5,000 for a procedure that costs you $10,000, you have a difficult time moving to a value-based care model.” This financial discrepancy, coupled with the complexity of patient needs, particularly those with chronic conditions, creates a significant obstacle. 

“The other problem is that you have complexities with patients that may or may not necessarily be encapsulated in that value based care fee. You’ve got comorbidity rates and chronic conditions that you can’t really encapsulate,” Zand said. “You can’t say ‘Oh, everybody should be able to pay $5,000 for that,’ because that’s not true. Some patients cost you a lot more, some patients cost you less.” 

“In general, the majority of our patients that have those chronic problems are actually the majority of the cost, so 80% of the cost of the hospital is for those patients whose healthier patients don’t cost them that much. The value based care model works for relatively healthy patients, but not for the 80%. That has been the difficult nut to crack.” 

The Role of AI in Healthcare Transformation

Despite the challenges, Zand expresses optimism about the potential role of AI in healthcare transformation. AI offers a promising solution by extracting insights from intricate, unstructured datasets, potentially aiding in cost assessments for patients grappling with multiple comorbidities. This approach recognizes that not all patients have the same needs, and some may have comorbidities or chronic conditions that require different considerations. 

“I actually really think that AI can help in this space. I think if we’re using artificial intelligence, we can actually do much better predictions of the patient’s outcome and leverage AI to set those value based care rates in the right way for the patient for the right patient,” Zand shared. “I think this is one of those tools that can actually accelerate VBC over the next few years.” 

Leveraging AI for Internal Efficiency and Cost Reduction

CereCore, under Zand’s leadership, is actively exploring how AI can enhance its internal efficiency and reduce costs. Initiatives include using AI to expedite helpdesk incident resolution and accelerate software development processes.  

Zand highlights a significant acceleration in processes that formerly spanned four months, now streamlined to mere weeks thanks to AI. Leveraging AI, CereCore achieves the rapid generation of analytics reports for hospitals, offering the potential for swifter and more cost-efficient service delivery.  

“Obviously, that’s not only pleasing for the hospital, but reduces costs, too,” Zand said. “The next phase of what we’re looking at is using AI to predict problems ahead of time.” 

Given CereCore’s role as a support network, their responsibilities encompass a wide array of functions, including the support of various applications and systems. This prompts the question of how we can effectively implement predictive analytics across this diverse spectrum of systems, Zand asks. 

“So before a network goes down, we actually have a heads up that this segment of the network might go down. Networks go down for various factors. So a series of events could actually lead up to your network going down, but we might not have the visibility of knowing the series of events are happening. With AI being connected to the different ecosystems that might have that information, we could get an alert telling us that, for example, this segment of New York City is having some problems with electricity and this might impact you. These alerts will give us information that otherwise we would be completely blind to,” explained Zand. 

“We’re also keenly looking at what’s happening in the EHR platform areas,” Zand continued. “We’re looking at automation, and hyper automation, and seeing if you can actually automate some of those tasks. It’s all about efficiency.”  

Employee Engagement and Resource Management

Improving efficiency is a paramount objective in any healthcare setting, as it not only saves valuable time but also minimizes the squandering of precious resources and energy. The ripple effect of enhanced efficiency extends beyond the operational realm, as it plays a pivotal role in mitigating burnout among healthcare professionals. By alleviating burnout, hospitals can anticipate a decrease in staff turnover rates. The positive impact reverberates through improved provider and patient satisfaction, ultimately creating a healthier and more harmonious healthcare environment. 

The past three years have been marked by substantial challenges as clinicians have left the profession in droves, with even more contemplating their exit.  Zand’s experience mirrors this trend. 

“I think the biggest challenge that we’re all talking about is resources. Getting the right resources – finding them, and then keeping them engaged,” Zand said.  

Zand emphasizes the importance of employee engagement in CereCore’s mission-driven approach. He notes that being a mission-based organization, focused on improving patient care, helps attract and retain talent. The commitment to a higher purpose beyond mere technology management resonates with both employees and clients. 

“Because of the fact that we are mission based, and we are going and what we’re doing is improving the lives of patients and improving the, you know, satisfaction of the physicians and the nurses and clinicians. It makes people feel good, and they want to be part of it,” Zand shares. “Those are the kind of things that make a difference when attracting labor.”