We created a space for payment integrity professionals to explore the use and adoption of artificial intelligence for better cost containment – and a more effective U.S. healthcare system.
by Musheer Ahmed, Codoxo’s Chief Executive Officer and Founder
In December 2023, management consultancy McKinsey reported that the payment integrity industry is on the cusp of transformation. The industry’s radical change is being driven in part by a dramatic increase in healthcare spending that is projected to outpace GDP growth. Another contributing factor is increased complexity in billing and claims processing stemming from new delivery models such as virtual and home care.
Industry stakeholders know the healthcare field is evolving rapidly, with skyrocketing costs and demand for affordable care requiring urgent attention. Yet there is cause for optimism: technology advancements are keeping pace to fuel continuous industry change. Among the most impactful healthcare innovations to date is artificial intelligence (AI). Beyond applications that diagnose and treat patients or facilitate drug development, AI is now broadly accepted as a strategic tool to streamline labor-intensive and complex healthcare operational and financial processes.
With an impending shift towards value-based care, and as new payment and reimbursement challenges are introduced, AI is proving to deliver utility in the form of faster, more accurate, and more efficient payment integrity solutions with bottom-line outcomes.
With the industry ripe for knowledge to help accelerate adoption, we are thrilled to introduce the AI for PI Community.
Connect, Share and Learn With Payment Integrity Peers
The AI for PI Community is the first and only centralized group devoted to the use of artificial intelligence in payment integrity. On LinkedIn, the community’s public page invites followers to stay tuned in to news and events relating to AI-driven payment integrity. The community’s private group offers a trusted setting for members to exchange ideas, share leading-edge strategies, and work together towards common goals.
In both locations, the AI for PI Community brings together diverse stakeholders dedicated to transforming the growing field of healthcare payment integrity. Our community spans healthcare and payment integrity leaders, tech innovators, and specialized practitioners including healthcare payer executives, clinicians, claims operations specialists, billing and coding analysts, fraud case investigators, AI solution providers and many other industry experts.
The AI for PI Community is not just a gathering of professionals; it’s a collaborative movement. By sharing AI insights, methods, and solutions, we are paving the way for a future where quality healthcare is both accessible and sustainable.
Working Together to Build Trust and Fight Financial Bloat
According to a Wolters Kluwer survey, a striking 86% of Americans are concerned about the lack of transparency in how AI in healthcare validates information and sources. Navigating consumer trust in this new era is essential. The AI for PI Community aims to share knowledge, foster trust, and make AI a cornerstone of healthcare payment integrity.
Our mission is to harness AI technologies to make significant strides in containing costs within the healthcare system. This initiative isn’t just for payers; it’s for anyone passionate about creating a more affordable and efficient healthcare landscape.
The AI for PI Community aims to:
1. Educate. Providing valuable insights into the realistic capabilities and limitations of generative AI technologies. This education helps professionals discern between overhyped expectations and practical applications.
2. Network: Facilitating connections among healthcare payment integrity professionals, enabling them to share best practices, use cases, and innovative strategies.
3. Inspire: Motivating thousands of healthcare payer teams, government agencies, and pharmacy benefit managers (PBMs) to adopt “shift-left” strategies. These strategies focus on early intervention to prevent issues before they escalate, thus safeguarding their bottom lines and contributing to a less costly healthcare system.
Leveraging AI to End Healthcare Worker Burnout
The Deloitte 2022 Survey of US Frontline Physicians highlights an alarming workforce talent crisis fueled by unprecedented levels of clinician burnout. A staggering 81% of surveyed clinicians reported experiencing high or moderate burnout, largely due to unnecessary or low-value tasks that divert their attention from patient care. Administrative requirements account for 32% of this burden, while tasks that could be automated or handled by others make up 20%.
Research from the US government and prominent medical associations further details this troubling trend, emphasizing its threat to patient care quality. These studies urge industry stakeholders to take proactive measures in addressing the burnout crisis. Healthcare payers are encouraged to invest in technology to streamline clinicians’ workflows, thereby eliminating low-value activities and leveraging automation to reduce the time spent on non-clinical tasks.
AI emerges as a pivotal solution in this context. By automating routine administrative tasks and optimizing workflows, AI can significantly reduce the workload on clinicians and department teams, allowing them to focus more on patient care and higher value work. This not only improves the quality of care, but also addresses the root causes of burnout, making the healthcare system more efficient and sustainable.
Why You Should Join the AI for PI Community
The AI for PI Community on LinkedIn is open to all healthcare payment integrity professionals interested in the application and value of AI.
Each week, we will share relevant industry news, events, and research to support healthcare payer, agency, and PBM teams in pursuing “shift left” strategies that protect bottom lines and reduce erroneous, wasteful or fraudulent expenses. Special attention will be given to innovative AI technologies, applications, and use cases that advance cost containment goals.
By joining, members gain access to:
- Exclusive Events: Participate in events that bring together thought leaders and experts in healthcare and AI.
- Peer-to-Peer Interaction: Engage with like-minded professionals, sharing experiences and insights.
- Latest Trends: Stay updated on the latest developments and trends in AI and healthcare payment integrity.
- Valuable Resources: Access a wealth of resources to enhance understanding and implementation of AI technologies.
AI for PI – Where Passion Meets Innovation in Healthcare Payment Integrity
“A small group of thoughtful, committed individuals can change the world.” This powerful idea, expressed by Margaret Mead, captures the reason why we started AI for PI. Since 2017, Codoxo has played an instrumental role in developing differentiated AI solutions that help healthcare payers, agencies, pharmacy benefits managers and other organizations to reduce unnecessary cost and risk.
By bringing together industry leaders and fostering innovation, the AI for PI Community is yet another way to build toward a future where quality care is more affordable to all. We are excited to light the fire, and we call upon every stakeholder to fuel this dynamic and exclusive think tank dedicated to advancing the use of AI in payment integrity.
Let’s revolutionize healthcare costs, together.
To join AI for PI Community, visit the AI for PI Group on LinkedIn and click “Request to Join.”
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