Technology central to sustainability, affordability of global healthcare industry

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Healthcare spending saw a steep decline during the COVID-19 pandemic with associated lockdowns, restrictions, and postponement of non-essential treatments. However, the trend is expected to be short-lived as COVID-19 vaccines and testing became widely available, and healthcare usage begins to rebound.

“Almost every year, and with very little exception, healthcare spending grows faster than global Gross Domestic Product. The numbers show that, over the past two decades, the average annual growth in health spending has consistently been above 2%[1]. Key cost drivers remain the same: Ageing populations, an increased demand for care, clinical and technology advances, and the expansion of public healthcare systems,” explains Neels Barendrecht, Chief Executive Officer for Agility Risk Solutions, winners of the 2021 Singapore Technology Excellence Awards’ Artificial Intelligence – Healthcare category.

Reducing clinical risk to extend health resources

To ensure the affordability and sustainability of the healthcare industry, many has turned to Artificial Intelligence (AI) as a solution. One of AI’s applications is early detection, where it can predict a person’s health risk and likelihood of a serious health event, such as heart attack or stroke. Equipped with this powerful information, risk management strategies can be implemented to support the patient’s health and help them avoid a potentially catastrophic health event in the near future.

An example is how Agility Risk Solutions’ technology analyses patient-specific data to instantaneously flag at-risk individuals. “From there, we are able to implement highly targeted strategies with a specific risk management focus. As example, our patient-centred programmes help patients to proactively manage their health and, as a direct result, drastically reduce hospital readmissions. For a Singaporean-based health insurer, an independent study showed that these types of interventions can yield a conservatively estimated 20% in claims cost savings,” says Dr Jacques Snyman, Medical Director for Agility Risk Solutions.

To illustrate how the technology enables better clinical outcomes, Agility interventions have yielded as much as a 50% reduction in hospital re-admissions when compared with insurers who use legacy systems and programmes.

“Due to the integration of the software, Agility’s patients are supported by a single Personal Healthcare Coordinator (PHC) who guides them at every step of their healthcare journey, as opposed to dealing with numerous agents for different interventions. From a patient perspective, this essentially means expert support in avoiding a catastrophic health event in the near future, which is good news in itself for the individual’s quality of life and their family. At the same time, it also reduces overall health costs by reducing clinical risk,” Dr Snyman explains.

Ensuring the efficient use of funds

Globally, health systems continue to grapple with issues relating to wasteful expenditure. Taking on many forms, such as fraud, incorrect processing of claims, and inconsistent benefit provision, human detection is typically a labour-intensive process that sees operational costs greatly increasing. In contrast, hyperintelligent technology systems are able to identify and flag these cases in real-time and with 100% accuracy.

Agility’s latest generation end-to-end risk management software platform with embedded intelligence, for example, applies over 67000 rules, algorithms and protocols, as well as AI machine learning processes, within milliseconds to adjudicate every healthcare claim in real time.

“The system starts off by actively checking the patient’s treatment and conditions for contraindications and potential health risks through finely attuned clinical protocols to prevent potentially harmful treatment combinations. At the same time, business rules are also applied to eliminate wasteful expenditure and ensure valid claims are paid immediately for optimal patient and client satisfaction,” Barendrecht explains.

As a direct result, the system reduces the administration burden, operational expenses, as well as healthcare costs by ensuring funds are efficiently used for clinically valid claims. In fact, Agility case studies indicate that operational expenses can be reduced by as much as 50%. Decreased human intervention in pre-authorisation and claims adjudication further helps remove the potential for human error due to consistency being applied.

The highly innovative system draws on big data and is constantly improving through machine learning, which detects new patterns and trends to improve clinical risk management on a continual basis, while fraudulent or wasteful claims are proactively detected immediately at line-item level before payment is granted.

“There is so much room for innovation in healthcare as AI and Machine Learning continues to shape the future of healthcare and answer the challenges faced by many healthcare systems around the world. Our recent Singapore Technology Excellence Award reaffirms this and places digital transformation strategies at the very heart of making quality patient-centric healthcare more affordable to more people across the globe,” Barendrecht concludes.