I'm sure everyone is aware of this news, but just to make it clear: The payers are in trouble. Profitable growth will not return until they find ways to reduce operating, back-office, and administrative costs, because high Medical Cost/Care Ratios are here to stay. As someone who has been privy to large payer operations, I can say there is significant room for improvement. However, bureaucracy and slow technology adoption continue to be major impediments. Luckily, the document-based, fax-oriented healthcare business model has the potential to overcome some of the most manual and mundane back-office problems by utilizing GenAi and LLMs, resulting in 200-400 basis points of additional profits. Yet, the inclination to develop their own solutions, or the desire to align with big brands like OpenAI, Microsoft, and Google, will likely result in nothing more than press releases and superficial market strategies. I worry that their natural tendency to cut costs by reducing headcount will perpetuate the inefficiencies, create backlogs, and ultimately reduce quality of care. #healthcare #healthinsurence #cvs #aetna #genai #llm #artificialintelligence #ai #technology #deeplearning #tech #innovation #data #dataanalytics #business #datascientist #automation #analytics #medicare #carequality #backoffice https://lnkd.in/g9Dbqacs
Guru Nadiger
3mo
Totally agree with you. My first hand experience pitching Latitude Health's UM solution driven by LLM and GenAI is that Payers would like to build on their own or buy comprehensive/holistic solutions where Speed to value is low and implementation risk is higher, rather than addressing focused problems like doc management, manual review etc.
It's like you've taken a magnifying glass to the healthcare sector's back-office dilemma. The reliance on outdated, document-heavy processes is a real bottleneck, and the irony is that while everyone's talking about cutting-edge GenAI and LLMs, the actual adoption is crawling at a snail's pace.
Sidney Haitoff
3mo
New transactional infrastructure is the only way out of this mess. It's time to replace the 40 year old chassis holding everyone back from true innovation.
Steve Ardire
3mo
Fawad Butt Been saying U.S. Healthcare System Broken for quite some time - 93% of Americans say their healthcare is not worth what it costs https://healthexec.com/node/214871 - Medical systems are in the 'sick care' business to put people on drugs, not take them off - Social determinants of health that drive 80% to 90% of health outcomes would improve health of individuals and communities and decrease pressure on doctors to treat medical conditions stemming from unhealthy environments that we can't change. - The Innovation #HealthCare Really Needs is Help People Manage Their Own Health with Prevention-as-a-Service and wellness to live healthier, happier life - AI augments clinician decisions to improve speed & quality and primary care moving from MD's to PA's and NP's as discussed in my recent webinar on Augmentedintelligence will become futureofwork in Healthcare https://tinyurl.com/h65tdrkf now > 5200 impressions One of my poll questions will healthcare clinics become the new primary care for Americans vs hospitals ? Yes <<< 75% agreed Cheers..Steve AI startup advisor 'force multiplier' https://www.forcemultipliersteveardire.com
Gautam Vij
3mo
Absolutely insightful analysis, Fawad Butt It's crucial to consider that while cutting costs might seem like a quick fix, the real game-changer could be in enhancing operational efficiency through innovative technologies like GenAi and LLMs. This approach not only promises cost reduction but also improves service delivery, which is essential for sustainable growth in the healthcare sector.
Sadly, this will result in providers and patients getting less. Lots to solve and fix. Add incentives to keep people well to the list, with a scarcity of docs and dollars, there really is no better way than start with that.
Well said. Extraordinary pace of growth should now pay dividends… investments in efficiency should be paramount… fortunately, technology has riper options!!
Malahat Qureshi
3mo
We saw similar at wba since last few years - problem with retail business with laser sharp margin also a contrebuting factors
Alexandru Armasu
3mo
Thank you for bringing this to our attention!
Analytics & Strategy Expert Driving Business Success
3moWow. That explains how CVS grew their MA business by 14% during 2024 open enrollment. Underpriced MA products that attracted members (although all MA plans are under pressure). see report excerpts below Gaining 14% more of something that is losing money is a tough hole to climb out of. As #WalmartHealth showed yesterday …healthcare is a business. So what is it going to be @aetna 1) increase premiums 2) decrease payments to docs 3) cut benefits 4) all of the above