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Artificial Intelligence: The Hope Beyond the Hype

By John Commins  
   August 29, 2017

"The idea there is to apply the supervised machine learning algorithms so we can identify where patients are unnecessarily having to wait between care locations and trying to eliminate that so patients don't have to wait six hours in the ER," Stewart says. "Standardizing the process of caring for people, that plays into the flow, that goes back to the care pathways work." 

AI algorithms have begun tracking invoices at Mercy, and forecasting monthly inpatient and outpatient claims and collections. "What proportion of those invoices will we collect and what do we need to book into what category? We've gone from 70% forecasting accuracy to greater than 95% accuracy in a few weeks," Stewart says. 

He says benefits of the improved insights through AI are savings between $14 million to $17 million tied to Mercy's clinical pathways in fiscal year 2016 (or roughly $800 savings per case for patients treated on a pathway), and in a pilot, Mercy saw a 24-minute reduction in emergency room wait time and reduced length of stay by 20% for patients treated in the ED.

"Mercy covers four states, so we have a lot of variety in the payer landscape. How do we think about all of those payers and groups of patients as a portfolio? Which ones do we need to take other action on from a financial standpoint? Are there more complex patients in this particular insurance group? Do we need to do more case management? We have a couple of large ACOs with some financial risk. How do we quantitate that risk across the portfolio of people we are supposed to take care of? It's a number of variables that you have to analyze to try to find trends and meaning, and it is just exponentially difficult to do." 

Mercy is also using AI to target sepsis. "This is one of the most difficult problems, and any clinician will tell you there are definitely some unsolved areas in sepsis that we just don't fundamentally understand," Stewart says. "This is another area where machine learning can be highly beneficial in finding patterns that have eluded the best and the brightest of human analysts."

Going forward, Mercy will use AI to anticipate the financial fallout from the churn in the insurance markets, owing to proposed changes to Medicaid, the health insurance exchanges created under the Patient Protection and Affordable Care Act, and the potential for upheaval if reforms proposed in Congress become law. 

John Commins is a content specialist and online news editor for HealthLeaders, a Simplify Compliance brand.

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