Facing Burnout and Changing Revenue Models, Healthcare Looks to Augmented Intelligence for Operational Improvements
Many health systems and hospitals suffered a severe financial shock with the onset of the COVID-19 pandemic in March 2020. With hospital operating margins already slim, such a shock can drive margins into negative territory and impact the survival of the organization. Because of this, the pandemic created an opportunity for a number of AI in Operations (AI4Ops) vendors to demonstrate a measurable ROI during the crisis, and emerge stronger for it.
While most of the attention in the AI space has focused on clinical applications, AI for operations - AI4Ops - is where the real action is today. Smart money is catching on to the potential market for reducing overhead and administrative waste in healthcare, with recent investments and M&A activity in this space reflecting that.
This report takes a closer look at several leading solutions in the AI4Ops space and provides an overview of the trends and dynamics of the market as it evolves post-pandemic:
- Change Healthcare (Flagship Vendor - RCM)
- Codoxo
- Health Catalyst
- HospitalIQ
- Infinitus
- LeanTaaS (Flagship Vendor - Operational Excellence)
- Olive
- Optum
- Qventus (Flagship Vendor - Hospital Operations/Change Mgmt)
- Waystar
The research focused on the largest segments of the operations spectrum from supply chains to hospital operations. We have also included a small number of supply chain and RPA vendors that we believe compose an important, but smaller segment than RCM and hospital operations.
The report covers a number of operational use cases including the following:
- Discharge Planning: ER management, Discharge barriers, Perioperative
- Hospital Operations: Staffing, Hospital beds, Surgery, Asset optimization
- Revenue Cycle Management (RCM): Intelligent claims management/denial prevention, Prior authorizations/eligibility, Patient ability to pay, Fraud detection
- Supply Chains: Predictive caseloads, Supply chain forecasting, Resource prioritization
Many healthcare organizations have been using point solutions for operations as they initially engage with AI, but the leading vendors are building multi-functional, end-to-end platforms across operations and RCM functional areas.
The report provides clear examples of how healthcare leaders can learn from other industries such as airlines and airport capacity management to improve their own operations. We also highlight vendors who excel at the change management component of AI4Ops, which is mission-critical to successful digital transformation.
As an essential piece of digital transformation, AI4Ops will continue to relieve the burden on an already stressed healthcare system and should prove a testing ground for developing trust in AI offerings within the healthcare industry.
Healthcare administrators and leaders looking for ways to improve their operations processes will find this report useful in assessing which vendor and solution is right for their organization’s needs. Operations executives can expect to find clear breakdowns on AI offerings that will alleviate many of the stresses facing their organizations today. Investors, solutions vendors will find value in the outlines of market trends as well as the competitive landscape, and the market sizing projections will assist in targeting customers for their products.
Table of Contents
Key Takeaways
- Definition of Market/Technology
- Key tech components
- Market Need and Predominant Use Cases
Common Buyers
Evolution in Technology & Strategies for Deployment and Use
Obstacles and Challenges to Adoption
Industry Context
- Business/economic
- Policy
- Regulations
- Societal
Market Forecast
- Forecast Notes
- Projected Five Year Growth by Sector
- Market Specific Trends
- Top Five Trends to Watch
Vendor Categories
Product and Market Categories and Descriptions
- Product Ratings
Market Categories
- Market Ratings
Analyst Bearings
Vendor Profiles
Appendices
- Appendix A: Methodology
- Appendix B: Overall AI4Ops Vendor Landscape
- Appendix C: Acronyms Used
Samples
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Executive Summary
This report on AI for healthcare operations forecasts a market poised for explosive growth with a CAGR of 40% over the next 5 years as solutions mature and more use cases demonstrate ROI.
The COVID-19 pandemic has irrevocably expedited the adoption of enterprise augmented and artificial intelligence (collectively AI) solutions in healthcare to modernize operations. Burnout and staffing shortages, discharge planning, supply chain interruptions, new contracting models, and other operational challenges have all contributed to quickly making these technologies business-necessary to keep many healthcare organizations (HCOs) functioning. The report, Augmented Intelligence for Healthcare Operations, examines an emerging niche of the industry poised for explosive growth as more 'mature' solutions effectively demonstrate the ROI of their client implementations.
Several vendors are rapidly moving towards building platforms that are end-to-end solutions for operations, rather than simply developing point solutions. The many acquisitions and investments that have taken place over the past 18 months show that buyers and developers are focused on early financial wins, competing across operations and RCM functional areas wherein ROI can be easily quantified. In addition, the nature of some of these solutions is strong enough that vendors are exploring taking on risk in their contracts, offering ROI-based contracting for their services as they assert the value of their platform.
When asked about the findings of the research, lead analyst Jody Ranck had this to say about the current market trends, "While there has been a great deal of focus on virtual care and the pandemic, a lesser-known story is the significant role of AI for operations platforms in helping hospitals and providers meet the financial, scheduling and supply chain challenges wrought by COVID-19. The solutions available today are surprisingly more mature than many other application areas for AI and machine learning."
A representative cohort of ten leading vendors providing solutions to address these needs is profiled in detail. The organizations who have developed products that meet the parameters of this research are: Change Healthcare (Flagship Vendor for RCM), Codoxo, Health Catalyst, Hospital IQ, Infinitus, LeanTaaS (Flagship Vendor for Asset Optimization), Olive, Premier, Qventus (Flagship Vendor for Hospital Operations), and Waystar. Smart money is catching on to the potential market for reducing overhead and administrative waste in healthcare, with recent investments and M&A activity in this space reflecting that. To date, this space is still largely untouched by the larger, incumbent platform vendors, so expect acquisitive behavior in the coming year from these stakeholders.
Although relatively early in its days of implementation, dividends from investments in the operations space are beginning to emerge. As a critical piece in the overall picture of digital transformation, AI4Ops will continue to relieve the burden on an already stressed healthcare system, and should prove a testing ground for developing trust in AI offerings within the healthcare industry. While risks remain when implementing these solutions, they are not as dire as the potential risks posed by clinical decision support or other care delivery-centric solutions; though all stakeholders will still need to be vigilant when checking for bias in their algorithms.
Healthcare administrators and leaders looking for ways to improve their operations processes will find this report useful in assessing which vendor and solution is right for their organization's needs. Operations executives can expect to find clear breakdowns on AI offerings that will alleviate many of the stresses facing their organizations today. Investors, solutions vendors will find value in the outlines of market trends as well as the competitive landscape, and the market sizing projections will assist in targeting customers for their products.
Companies Mentioned
- Change Healthcare
- Codoxo
- Health Catalyst
- HospitalIQ
- Infinitus
- LeanTaaS
- Olive
- Optum
- Qventus
- Waystar
