Becker's Hospital Review

13 CFO / FINANCE Big data creates 'entirely new revenue streams' for health systems By Alan Condon H ospitals are tinkering with artificial intelligence solutions to alleviate cost pressures, but the safe integration of AI can be a challenging endeavor, not a quick fix to decrease spending. Seventy-nine percent of healthcare facilities use or plan to use AI technologies to curate clinical data, with nearly half of these facilities identifying reduced administrative tasks as their primary goal with AI this year, according to a recent survey published by clinical data management company Q-Centrix. AI has the potential to significantly save time and lower costs, but the risk an AI model can introduce compared to an individual's impact is significant. "Models create model-sized problems; inevitably, someone is going to be in the headlines because [large language models] broke something that negatively impacted a large patient population," Brian Foy, chief product officer at Q-Centrix, said. "The only way to avoid the risk is with precision — but precision at scale is extraordinarily complex, and it requires a combination of access, technology, and human intervention. Unless hospitals are willing to take a thoughtful, long-term AI approach that includes all these elements — or partner with an organization that has a proven track record for exploring AI safely — they may need to consider other ways to reduce costs." Health systems aren't just using AI to reduce costs; they're also exploring new growth opportunities in areas traditionally seen as cost centers, such as quality. Using clinical data sets from registries for research creates new ways to generate revenue. Three-quarters of hospital leaders surveyed said their facility is currently sharing or plans to share de-identified clinical data with other organizations for research purposes, but almost two-thirds of clinical trials fail to enroll enough patients for an effective study, according to the report. "Hospitals sit on a mountain of data that can be used for research, and leaders are starting to realize how much value that data holds for the communities they serve," Victor Wang, senior vice president of data and research at Q-Centrix, said. "Exploring these types of expansions of their clinical data usage has great potential for hospitals: they can contribute to life-saving research, offer patients early access to innovative treatments, and stay competitive. Providing their data for funded research opportunities opens up entirely new revenue streams for hospitals." n SCAN was one of the MA payers that Scripps terminated with this year. "Providers are going to have to get out of full-risk capitation because it just doesn't work — we're the bottom of the food chain, and the food chain is not being fed," Mr. Van Gorder said. "If other organizations are experiencing what we are, it's going to be a short period of time before they start floundering or they get out of Medicare Advantage. I think we will see this trend continue and accelerate unless something changes." Ultimately, it's the patients who lose out, as MA provides coverage to 51% of the nation's seniors, almost 33 million people. To compound this issue, MA plans typically receive positive patient satisfaction scores, with high ratings in areas such as trust, ease of doing business, and meeting product and coverage needs, according to an August 2023 study published by J.D. Power. "e reason for that is there is a higher degree of predictability in out- of-pocket costs. Every MA plan in the country has an out-of-pocket maximum like commercial insurance has, and that affords people a higher degree of predictability in terms of their healthcare expenses," Dr. Jain said. "When you're on a fixed income, it's really important to have that level of predictability in terms of what your costs are going to be, and traditional Medicare doesn't necessarily offer that level of predictability to people." A survey of hospital CFOs published by the Healthcare Financial Management Association in January found that 16% of health systems plan to stop accepting one or more MA plans in the next two years, while another 45% said they were considering the same but have not made a final decision. Dr. Jain argues that health systems need to make a firm decision: "Are you in the sick care business or are you in the healthcare business? If you're in the healthcare business, you should be striving to prevent acute care utilization, not driving more of it. And you want to be in a business model that's aligned with preventing acute care utilization, and MA is that model." Providers need to update their business models to align with being financially rewarded for keeping populations healthy, and there are certainly some investments that are required to make this pivot. "But the order of magnitude in terms of the investment necessary and the reserves of some health systems is de minimis," he said. "It's really about getting the type of leadership you need in place and empowering those leaders to really manage the population's health." Dr. Jain argues that the MA program genuinely makes a difference in the lives of older adults — something he says is missing from some systems' value equations. "If you're a health system exec that's thinking about terminating a program that's used by 51% of the nation's seniors, you have to ask, 'Who is it that you're actually serving, and who are the people that you're trying to serve through your system?' I think a lot of systems thinking about terminating MA aren't necessarily thinking about their mission through that lens." n

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