FEATURE

Smart use of artificial intelligence in

health care
Seizing opportunities in patient care and business activities
Kumar Chebrolu, Dan Ressler, and Hemnabh Varia

THE DELOITTE CENTER FOR HEALTH SOLUTIONS

Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

For the health care industry, AI-enabled solutions can provide immediate
returns through cost reduction, help with new product development,
and lead to better consumer engagement. We explore how health care
organizations can scale up their AI investments by pairing with a robust
security and data governance strategy.

A
RTIFICIAL INTELLIGENCE (AI) is already • Top outcomes health care organizations are
delivering on making aspects of health care trying to achieve through AI are making
more efficient. Over time it will likely be processes more efficient (34%), enhancing
essential to supporting clinical and other existing products and services (27%), and
applications that result in more insightful and lowering costs (26%).
effective care and operations. AI has multiple use
cases throughout health plan, pharmacy benefit • Respondents from health care organizations
manager (PBM), and health system enterprises reported that their main concerns about risk
today, and with more interoperable and secure with AI were the cost of the technologies (36%),
data, it is likely to be a critical engine behind integrating AI into the organization (30%), and
analytics, insights, and the decision-making implementation issues, including AI risks and
process. Enterprises that lean into adoption are data issues (28%).
likely to gain immediate returns through cost
reduction and gain competitive advantage over the The current pandemic overwhelmed health
longer term as they use AI to transform their systems and exposed limitations in delivering care
products and services to better engage and reducing health care costs. The period from
with consumers. March 2020 saw an unprecedented shift to virtual
health, fueled by necessity and regulatory
Deloitte conducted the State of AI survey in late flexibility.1 The pandemic opened the aperture for
2019 which featured questions around how digital technologies such as AI to solve problems
organizations are adopting, benefiting from, and and highlighted the importance of AI. Even though
managing AI technologies by industry. This survey the survey was fielded before the public health
was conducted before COVID-19 significantly crisis, some of the outcomes and challenges that
impacted the United States. The survey found that: health care organizations had in using AI prior to
the pandemic will likely continue to be instructive
• Health care organizations vary significantly in as health systems, health plans, and PBMs develop
their AI investments: Seventy-five percent of their new AI investment strategies.
large organizations (annual revenue of over
US$10 billion) invested over US$50 million in Health systems were challenged by historic lower
AI projects/technologies, while approximately revenues due to nonurgent care and were forced to
95% of mid-sized organizations (annual scale back during the pandemic. They can expect to
revenue of US$5 billion to US$10 billion) gain advantage by using AI for applications to
invested under US$50 million. Seventy-three support cost savings as they transform.
percent of all organizations expected to increase
their funding in 2020. Health plans and, in the longer-term, health
systems, can use AI-enabled solutions to gain
insights, develop new products and services, and

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 Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

better engage with consumers. Health plans can AI uses algorithms and machine learning (ML) to
also use AI to proactively detect and manage fraud, analyze and interpret data, deliver personalized
waste, and abuse, resulting in recovered payments experiences, and automate repetitive and
and cost avoidance, saving them millions and expensive health care operations. These functions
improving patient care. have the potential to augment the work of both
operational and clinical staff in decision-making,
This could well include an expansion of AI’s reach reduce the time spent in administrative tasks, and
into clinical and back-office applications. Even as allow humans to focus on more challenging,
health care organizations step up their investments interesting, and impactful management and
into data and analytics with AI, they should pair clinical work.
these with a robust security and data governance
strategy. Today, health care organizations experience
pervasive problems across their value chains,
spanning every process on the continuum from
Introduction care to cure. In the future, health care
organizations that apply AI across every process
AI is gaining traction in health care, starting with from care to cure can improve the health and well-
automating manual and other processes, and the being of consumers. Deloitte’s Cognitive Care to
number of use cases and sophistication in the use Cure solution is an AI-powered, cloud-based,
of the technology is growing. In our vision of the digital health care solution-as-a-service that can be
Future of Health, we view radically interoperable applied across the health care value chain to
data as central to the promise of more consumer- improve operational efficiencies, reduce costs, and
focused, prevention-oriented care, and analytics as support better health outcomes for consumers
critical to using the vast data that will be generated (figure 1). These are all on the same platform and
by ubiquitous sources. AI has already become can offer efficiency to organizations looking for
embedded into analytics and is likely to become multiple solutions. They are also available as
even more so in the future. individual services, allowing health care
organizations to choose from a menu of offerings
that meet their needs and strategy.

OVERVIEW OF AI
The term artificial intelligence is used for computer systems that perform human-like, mental
tasks, such as visual perception, speech recognition, and decision-making based on data patterns.
According to Deloitte’s Taking AI to the next level article, the key attributes of AI systems are:

• They learn. Unlike traditional computer systems that are programmed to follow a set of rules, AI
systems get smarter over time and have the potential to deliver superior outcomes.

• Their core capabilities are like human intelligence. Pattern recognition, categorization, anomaly
detection, and regression and prediction are good examples. AI can apply these capabilities
to data sets and challenges that are far richer and more complex than those that humans
can handle.

• AI is not just a single technology but a rich set of development techniques and
problem-solving approaches.

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Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

FIGURE 1

Cognitive Care to Cure solution portfolio and health care value chain
Our health care value chain
DISCOVERY &
ACQUIRE/ CLAIMS/
PREVENTION DIAGNOSIS TREATMENT RECOVERY SERVICE ENABLING
ENROLL PAYMENT
FUNCTIONS

Underlying platform
Deloitte’s Care to Cure cognitive platform

HealthcareX marketplace platform

AI solution marketplace that gives clients access to scalable and verified intelligent solutions supporting
Plan, Provider, and PBM

Transformational capabilities
AI-ENABLED SMART AUTONOMOUS PERSONALIZED DIGITAL
CARE WORKFORCE MONITORING SERVICES AUTHORIZATION
Monitoring, routing, AI-driven tools that Anomaly AI-assisted call Frictionless
and delivery of optimize resource identification across center, sales agents, automation and
virtually/in-person and talent the health care and voice analytics next-gen contracting
allocations ecosystem

Source: Deloitte analysis.

Deloitte Insights | deloitte.com/insights

RESEARCH METHODOLOGY
Between October and December 2019, Deloitte’s Center for Technology, Media &
Telecommunications surveyed 2,737 IT and line-of-business executives around the world to
understand how organizations are adopting, benefiting from, and managing AI technologies by
industry. Deloitte’s Center for Health Solutions analyzed the responses from 120 executives in health
care organizations to understand the current and anticipated investments, top priorities, and AI risks
and concerns related to health care organizations. Of these responses, 87 were from executives in
US health care organizations while the remaining 33 were from regions including Australia, Canada,
China, France, Germany, Japan, and the Netherlands.

We also interviewed a leader in a large national health plan to include insights on current
applications of AI in that organization and what the future could hold.

Current applications of AI in AI can automate tedious administrative work and

health care be used to generate insights for monitoring fraud
and abuse or physician practice patterns, as well as
Like every industry, health care is adopting AI augment humans to support better health
solutions in many aspects of its work (figure 2). outcomes.
Although AI applications in clinical settings have
received much press, many of the day-to-day Health systems and health plans are likely to
nonclinical operations, including the business of emerge from the response to COVID-19 with a
submitting and paying claims are ripe for AI. renewed focus on efficiency and affordability. The
Natural language processing can understand American Hospital Association estimates US
unstructured data from electronic health records. hospital revenue losses to increase by US$120.5

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 Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

FIGURE 2

A few applications of AI in health care by type of operation

Clinical Non-clinical

Efficiency Efficiency

• Symptom analysis for COVID-19 • Automating administrative tasks

• Accelerating scientific discovery • Accelerating and amplifying insights
processes generation
• Smart workforce management: • Fraud, waste, and abuse (FWA)
- Planning and scheduling detection and prevention

- Talent crowdsourcing

Risk Management Customer Experience

• Medication-related error detection • Conversational AI

Source: Deloitte analysis.

Deloitte Insights | deloitte.com/insights

billion from July through December 2020,

bringing total losses to around US$323 billion this
year.2 Although health plans have remained
financially buoyant through 2020, they are
“Health plans are utilizing the
watching for economic trends that may result in power of AI to make better
more of their enrollees getting coverage through
Medicaid and health insurance exchanges, which
predictions from data for external
tend to pay less than commercial employers. and internal stakeholders—
Solutions that will deliver savings and efficiency
have never been more relevant, and AI is proactively reaching out to
embedded in many of these.
consumers with information on
INCREASING EFFICIENCIES AND disease progression and next best
MINIMIZING RISKS IN CLINICAL
OPERATIONS
action for care, and supporting
AI-based solutions can effectively streamline physicians in clinical decision-
diagnostic and treatment processes by using large
amounts of structured and unstructured medical
making by arming them with the
data across institutions. This can aid physicians at right insights.”
hospital and health systems in clinical decision- — Ashok Chennuru, Chief Data and Analytics Officer,
making by providing them with real-time, Anthem Inc

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Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

IMPROVING PATIENT OUTCOMES WITH AI

• AI-based analytics for supporting the decision-making process: Researchers at the Mount
Sinai health system recently developed an AI algorithm to rapidly detect COVID-19 by integrating
patients’ chest CT scans with clinical information including symptoms, age, blood reports, and
possible contact with infected people. The algorithm mimics the physician workflow used to detect
COVID-19 and provides a final analysis using separate probabilities of CT images, clinical data, and
both combined. The AI system also detected 68% of COVID-19-positive cases in situations where
radiologists interpreted those cases as negative due to the negative CT appearance. The system
can be effectively used to provide a second opinion to physicians and to triage or prioritize the
evaluation of infected patients early in their admission to the emergency room.3

• Accelerating scientific discovery processes: AI health care company Imagia has collaborated
with US and Canadian hospitals to accelerate health care discoveries through its EVIDENS
platform. The platform empowers clinicians to structure data from live hospital systems by
enabling automated data segmenting and labeling. It transforms unstructured clinical patient
data into outcome-based structured information, thus scaling up traditional scientific discovery
processes. The hospitals are working in collaboration to improve medical outcomes for lung
cancer patients by analyzing treatments and results with the EVIDENS platform.4

data-driven insights that they can alter and major challenge for health systems since the onset
implement based on their personal expertise (see of the pandemic—by factoring in operational
the sidebar, “Improving patient outcomes with constraints such as the number of staff, availability,
AI”). skills, and specific equipment required (see sidebar,
“Smart workforce management with AI”).
AI-powered solutions can assist in accurately
scheduling and planning clinical staff rotation—a

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 Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

SMART WORKFORCE MANAGEMENT WITH AI

• Norway-based Globus.ai’s AI-enabled system uses NLP, deep learning, and ML to extract
information, match the competencies of health care workers to specific tasks, and help fill
available slots, making the planning of medical staff rotation easier and more efficient. This has
been saving hospitals 90% of the time it takes to fill each slot.5

• Deloitte’s smart workforce solution can help health care organizations realize workforce goals
with the use of talent crowdsourcing (i.e., the gig economy). The solution provides clinicians with
access to an internal crowdsourcing platform to complete activities, including top-of-license
tasks, and uses AI-based analytics to optimize skill matching and workload requirements (internal
clinical gig economy). The solution also supplements the traditional workforce with gig clinicians
to complete routine activities during peak seasons and uses AI-based analytics to inform dynamic
compensation for clinical services (external clinical gig economy). Core offerings include:

– Automatic resource allocation based on needs, historical preferences, and expertise across all
in-network facilities

– Clinical and operational task prioritization based on urgency, including real-time reminders and
progress tracker

– Efficiency solutions to reduce labor-intensive tasks through automation (e.g., patient

scheduling, data exchange)

– Efficiency solutions expediting administrative burden (i.e., utilization management, prior

authorization)

AI can also minimize patient risk by identifying positives—one of the reasons of physician burnout
medication errors that traditional rule-based (see sidebar, “Minimizing safety risks through
clinical decision support systems are unable to medication error detection with ML”).
detect, while also reducing alert fatigue and false

MINIMIZING SAFETY RISKS THROUGH MEDICATION ERROR DETECTION WITH ML

Israel-based MedAware’s patient safety platform applies advanced ML algorithms and outlier
detection mechanisms to identify and prevent medication-related errors and risks. The platform
flags medications that conflict with the profile of the patient, physician, or institution. MedAware
flagged 10,668 potential errors and adverse drug events in the records of 373,992 patients treated
in the outpatient clinics of Massachusetts General and Brigham and Women’s Hospitals. In an
analysis done on a random sample of 300 warnings generated by MedAware, 92% of the warnings
were accurate based on data available, 79.7% of the warnings were clinically valid, and 68.2% of the
warnings would not have been flagged by existing decision support systems.6

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Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

OPTIMIZING NONCLINICAL OPERATIONS WITH AI

• Achieving time and cost savings by automating administrative tasks: Ohio-based Olive’s AI
Workforce solution is designed to automate a selection of tedious, high-volume administrative
tasks in various departments of a health care organization such as revenue cycle. Olive uses ML to
find patterns among its data feeds, allowing the tool to identify workflows and processes suitable
for optimization. To date, Olive has completed over 450,000 claim status checks and processed
more than 250,000 charge corrections for its clients.7

• Accelerating and amplifying insights generation: HealthcareX is a self-service platform with

analytics, AI, and visualization capabilities developed by Deloitte to accelerate and amplify insight
generation for health systems and health plans. HealthcareX can be used to federate data from
multiple sources to one location, remove manual data collection processes, standardize data
using preset functions to ensure data integrity, uncovering and exploring connections in data,
and creating tailored insights. This eliminates the need for multiple systems and allows the
organization to enhance the decision-making process. An application of the HealthcareX tool is to
analyze member population to predict high-cost claimants for health plans.

• Enhancing customer experience through conversational AI: The COVID-19 pandemic has led
to patients making more phone calls and rapidly adopting virtual health, exposing the limitations
of health systems. This has set the groundwork for a digital front door. Deloitte’s DocTA is an
omnichannel experience powered by conversational AI integrated at the contact center to resolve
administrative inquiries and steer consumers to appropriate endpoints of care.

INCREASING EFFICIENCIES AND According to the Journal of the American Medical

ENHANCING CUSTOMER EXPERIENCE IN Association (JAMA), approximately 25% of US
NONCLINICAL OPERATIONS spending on health care is wasteful, translating
The ability of AI to examine large amounts of into an estimated US$760–935 billion wasted
information quickly can help hospital and health every year.8 However, AI-based analytics present
plan administrators optimize performance, the opportunity for health plan companies to detect
increase productivity, and improve resource and reduce improper billing practices for
utilization, resulting in time and cost efficiencies. streamlined member billing. Additionally, PBMs
Additionally, AI-enabled solutions can speed up can use AI to integrate and assess patient medical
and strengthen the insight generation process by information to resolve issues in real time, leading
allowing the organization to gain the holistic to improved patient care experience. AI can also
picture it needs to make data-driven decisions. help to effectively and proactively identify potential
Finally, AI can also deliver personalized fraud, waste, and abuse (see sidebar, “Realizing
experiences by facilitating conversations with efficiency through fraud, waste, and abuse [FWA]
patients through virtual assistants (see sidebar, detection and prevention”).
“Optimizing nonclinical operations with AI”).

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 Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

REALIZING EFFICIENCY THROUGH organizations begin to scale up their AI

FRAUD, WASTE, AND ABUSE (FWA) applications based on their short- and long-term
DETECTION AND PREVENTION priorities, they should be mindful of risks
• Deloitte Risk and Financial Advisory’s during implementation.
Program Integrity solution is an end-to-
end solution that integrates and analyzes AI INVESTMENTS IN HEALTH CARE VARY
provider claim data using ML models WIDELY; PAYBACK PERIOD IS IN LINE
to develop comprehensive analytics for WITH EXPECTATIONS
the identification of potential fraud and Surveyed leaders agreed that health care
improper payment. The solution continues organizations are investing, but the investments
to support a large national health plan vary widely. Seventy-five percent of large
in reducing improper payments through
organizations (annual revenue of over US$10
various initiatives, one of them being by
billion) invested over US$50 million in AI projects/
creating a data-driven advanced analytics
technologies, while approximately 95% of mid-
anomaly detection solution that applies
sized organizations (annual revenue between
ML techniques to existing data to uncover
risks and provide an enterprise view of US$5–10 billion) mostly invested less than US$50
hidden behaviors and trends across all million (figure 3). Seventy-three percent of these
lines of business. health care organizations also expect their
investments in AI to increase in the next fiscal
• Prime Therapeutics, a PBM, is using an
year.11 Additionally, most of the surveyed leaders
AI solution to identify FWA, assisting
believe that the actual payback period for their
health plans with cost savings and
organization’s AI investments is in line with their
improving patient care. The AI platform
integrates pharmacy and medical claims expectations.12
data from prescribers, pharmacies, and
members. Investigators can link a patient’s TOP PRIORITIES INCLUDE INCREASING
prescriptions to a diagnosis and associated PROCESS EFFICIENCY, ENHANCING
medical visits, and also monitor for drug CUSTOMER OFFERINGS, AND LOWERING
overutilization. The company has saved COSTS
US$355 million in recovered payments AI has the potential to create new efficiencies in
and cost avoidance for health plans since administrative processes and provide a precise and
mid-2018.9 faster diagnosis and treatment plan for each
patient, resulting in reduced length of stay, fewer
subsequent readmissions, and reduced costs.
Current and anticipated
investments, top priorities, When asked about the outcomes organizations are
trying to achieve through AI, surveyed health care
and risks and concerns with AI
leaders cited more efficient processes as their top
Interest in AI in health care has surged since last priority (34%). Enhancing existing products and
year as provider and payer organizations seek to services (27%) and lowering costs (26%) are a
tap the potential benefits offered by data-driven distant second. None of these organizations has
analysis and deep neural networks.10 Clinicians are achieved all outcomes to a great extent, but making
more open to digital technologies, since they processes more efficient comes the closest (43%)
experienced firsthand during the pandemic how (see figure 4).
these technologies augmented their skills in areas
including surgery and diagnosis. As these

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Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

FIGURE 3

Organizations with higher annual revenue invest more heavily in AI

Q: How much did your organization invest in AI projects/technologies in the most recently completed
fiscal year?

75.0%

63.2%

55.0%
Annual revenue

42.9% 42.5%
38.1%
35.0%
30.0%

22.5%
19.0%
15.8% 15.8% 15.0%
10.0% 5.3%
5.0% 5.0% 5.0%

Less than $1 From $1 million to less From $10 million to From $20 million to less $50 million
million than $10 million less than $20 million than $50 million or more

AI investment
$250 million to less than $500 million $500 million to less than $1 billion

$1 billion to less than $5 billion $5 billion to less than $10 billion

$10 billion or more

Note: All dollar amounts are in US$; Total number of respondents, N=120 (US=87, other global
regions=33)

Source: Deloitte’s State of AI survey.

Deloitte Insights | deloitte.com/insights

Another Deloitte survey, conducted in February TOP CHALLENGES INCLUDE COST

2020 and with a focus on physicians, had similar OF AI SOLUTIONS, AI INTEGRATION
findings. Seventy-three percent of the surveyed PROBLEMS, AND AI IMPLEMENTATION,
physicians reported that saving time and resources DATA, AND RISK ISSUES
is expected to be the No. 1 benefit of AI. Survey respondents pointed to poor-quality data,
Additionally, over 50% of surveyed physicians said siloed data systems, high initial costs of AI
they would increase their use and support of solutions with low return on investment, and
AI-driven solutions if they are shown to improve integrating AI into legacy systems as concerns.
efficiency and quality. 13

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 Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

Surveyed leaders indicate that the top challenges Risks and trust framework
faced by their organizations include cost of systems
(36%), integrating AI into the organization (30%), As investments in AI increase and AI-powered
and AI implementation, data, and risk issues (28%) solutions become more widespread in health care
(see figure 5).14 When asked about ethical risks, settings, the industry should address the new set of
they mentioned that they were most worried about challenges both from the data used—including
safety concerns around AI-powered systems cyber threats—and the potential for bias in the AI
(28%). 15
Additionally, findings from the 2020 algorithms. The strategy should comply with
Survey of US Physicians indicate that 69% of the regulations—including to assure patient privacy
physicians are concerned about who is liable when and other HIPAA requirements (figure 6).
AI-driven solutions make a mistake.16

FIGURE 4

Making processes more efficient is the most important outcome, followed by

enhancing existing products and services, and lowering costs
Please select the top 2 most important outcomes Please rate to what extent* you have achieved
you are trying to achieve the following outcomes through your AI
implementations
Making processes more efficient Making processes more efficient
34% 43%
Enhancing existing products and services Enhancing existing products and services
27% 32%
Lowering costs Lowering costs
26% 36%
Improving decision-making Improving decision-making
20% 38%
Creating new products and services Creating new products and services
20% 38%
Enabling new business models Enabling new business models
18% 36%
Enhancing relationships with clients/customers Enhancing relationships with clients/customers
17% 32%
Making employees more productive Making employees more productive
14% 34%
Discovering new insights Discovering new insights
14% 32%
Reducing headcount Reducing headcount
10% 33%

Note: Total number of respondents, N=120 *Achieved to a high degree

Source: Deloitte’s State of AI survey.

Deloitte Insights | deloitte.com/insights

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Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

FIGURE 5
AI algorithms present risks such as variability of
High cost of AI systems is companies’ output in patient diagnosis and treatment, data
No.1 challenge, followed by AI bias, and traditional IT risks such as change
integration and implementation issues management. Health care organizations should
and data and risk issues verify the integrity and accuracy of their AI
Q: Which of the following are top challenges for algorithms by focusing on:
your organization’s AI initiatives?
• Data strategy: Organizations should start
Integrating AI into the organization
30% incorporating inclusivity, equity, and fairness
into the data collection process, training and
Managing AI-related risks testing of AI algorithms equally well across
28% different geographical regions. They should also
The high cost of AI technologies/solutions conduct an internal audit and testing for AI
36% systems and ensure that AI vendors provide
unbiased systems. Understanding the data
Data challenges
strategy and process is critical to minimizing
28%
bias in the AI model.
Challenges implementing AI technologies
28% • Testing: Testing of ML or cognitive algorithms
doesn’t fall into the traditional test case
Choosing the right AI technologies
27% construct where the actual results can be
compared to an expected result repeatedly with
Lack of executive commitment the same outcome. Learning algorithms will
21%
produce varying outputs each time they learn.
Challenges proving business value Organizations should think about testing
19% data differently.
Difficulty identifying the use cases with the
greatest business value
• Monitoring: Because learning algorithms
19%
adjust to new data over time, what they learn
Lack of skills should be monitored to ensure it stays within
17% the acceptable control limits. This is a critical
component for maintaining validation and
Operational Technology compliance in the operational state.
Organizational

Note: Total number of respondents, N=120

Source: Deloitte’s State of AI survey.

Deloitte Insights | deloitte.com/insights

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 Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

For health systems and health plans to achieve • Include policies that clearly establish who is
their business objectives, they should: responsible and accountable for the AI
output. Key factors to consider include which
• Ensure multistakeholder buy-in on
rules and regulations might determine legal
validating the entire AI life cycle and the
liability and whether AI systems are auditable.
organizational/human processes that surround
the AI system.
• Ensure transparency by informing the
• Ensure strong governance practices consumers how their medical data is being used
around AI to enable organizations to innovate by AI to make decisions. AI’s algorithms,
with confidence while reducing the risks that attributes, and correlations should be open to
come with complex technology. inspection, and its decisions should be
fully explainable.
• Ensure patient data privacy and
protection from cyber threats by
addressing all kinds of risks—external, physical,
and digital, among many others—and assess
whether the potential benefits sufficiently
outweigh the associated risks.

FIGURE 6

A strategic approach to digital risk management for securely scaling AI

Digital risk management framework

Business objectives

Boost Enhance
Reduce Raise Enhance Increase Improve Raise Increase
employee customer
costs productivity insights scalability quality compliance margins
happiness experience

Attributes of a successful automation program

Executive Stakeholder Effective Controlled Active Transparency and Ability to
support buy-in prioritization development governance communication scale automation

Risks of automation
Operational, organizational, regulatory, financial, strategic, technology and cyber, AI risks

How to effectively manage risks and scale automation

Organizational Planning and Policies and Governance and Controls & Strategic
engagement alignment standards oversight procedures initiatives
The programs and The methodologies and Expectations for the The organizational Processes to manage the Strategy, communication,
methods for engaging processes to effectively development, structure, committees, first (“operations and risk engagement, and training
the workforce in identify, value, prioritize, management, and risk and roles and management”) and to promote an
automation opportunity and align on automation mitigation of automation responsibilities for second (“risk oversight”) automation-augmented
identification and opportunities technologies managing automation lines of defense workforce
collaboration environments

Center of Excellence (CoE)

The organizational structure to provide strategy, governance, and management of automation environments

Source: Deloitte analysis.

Deloitte Insights | deloitte.com/insights

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Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

Implications, call to action insights for medical and organizational

management, and client outcomes, to complement
AI is delivering significant business benefits today— the company’s overall positioning and strategy.
and its potential to shape the future of
the health care industry is even greater.
Health care organizations that are still
“It is essential for health care
in the experimental pilot phase stand to organizations to understand
be left behind by payers
and competitors.
how to automate processes by
reimagining them. That’s where
For health systems: To prepare for
the Future of Health, health systems AI can help. The ‘digital-first, AI-
should move from the experimental
stage to having data and advanced AI as
first, insights-driven organization’
a core capability. mindset needs to be incorporated
Health systems are currently under a lot
into every business unit of
of financial stress. For them, the short- the enterprise with a focus on
term focus might be on investing in AI
approaches that will help them achieve
automation.”
cost savings. Some examples of these — Ashok Chennuru, Chief Data and Analytics Officer,
Anthem Inc.
are provider profiling (supply chain);
fraud, risk, and abuse detection and
prevention; and automating health care operations. For PBMs: PBMs need to focus on determining
and improving communication channels with
Over the longer term, health systems can invest in health plans and use AI to optimize staffing and
more transformative AI applications to improve distribution activities. They should invest in AI to
their competitive positioning, achieve profitable enable proactive management resulting in effective
growth, engage consumers, and deliver savings programs and pharmacy programs
personalized customer experiences. Health systems designed to improve the patient journey.
should actively cultivate their relationships with AI
start-ups, technology and professional services As all health care organizations figure out how to
firms, and academia, and consider taking a more scale up AI-led innovations, they also should
active role in AI innovation. They should also manage AI’s unique risks.
encourage stakeholders, including physicians,
clinical staff, and administrative staff to strive to be Deloitte’s Trustworthy AI framework can help
champions and promote an AI-augmented health care organizations identify and manage AI
workforce. risks effectively to enable faster and more
consistent adoption of AI.
For health plans: Some health plans are already
investing deeply in data and AI-based analytics.
The focus should be to use AI to improve health
insurance cost-efficiency, consumer engagement,

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 Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

Endnotes

1. Ken Abrams et al., How the virtual health landscape is shifting in a rapidly changing world, Deloitte Insights,
July 9, 2020.

2. American Hospital Association, “Hospitals and health systems continue to face unprecedented financial
challenges due to COVID-19,” June 2020.

3. Mount Sinai, “Mount Sinai first in US to use artificial intelligence to analyze coronavirus (COVID-19) patients,”
press release, May 19, 2020.

4. Imagia, “Imagia partners with top US and Canadian hospitals to facilitate AI accelerated healthcare discoveries,”
Business Wire, December 17, 2019.

5. Globus.ai, “Norwegian tech-company attracts international attention,” July 8, 2020; Anu Thomas, “How hospitals
can tap AI to manage staff better amid Covid-19 crisis,” Analytics India Mag, April 11, 2020.

6. MedAware, “Harvard researchers find significant clinical impact and cost savings with MedAware’s patient
safety platform,” PR Newswire, December 16, 2019.

7. Olive, “Olive set to achieve record growth in 2019, digital employee hired at more than 500 hospitals,” Global
Newswire, September 26, 2019.

8. Dan Starck, “Industry voices—we need to fight fraud the right way,” Fierce Healthcare, November 18, 2019.

9. SAS, “Prime Therapeutics saves its clients $355 million in 18 months with AI-powered SAS Detection and
Investigation for Health Care,” accessed September 22, 2020

10. Heather Landi, “Investors poured $4B into healthcare AI startups in 2019,” Fierce Healthcare, January 22, 2020.

11. Beena Ammanath, David Jarvis, and Susanne Hupfer, Thriving in the era of pervasive AI: Deloitte’s State of AI in the
Enterprise, 3rd Edition, Deloitte Insights, July 14, 2020.

12. Ibid.

13. Deloitte, Deloitte 2020 survey of US physicians, 2020.

14. Ammanath, Jarvis, and Hupfer, Thriving in the era of pervasive AI.

15. Ibid.

16. Deloitte, Deloitte 2020 survey of US physicians.

15
Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

Acknowledgments

PROJECT TEAM:
Sarah Thomas provided invaluable guidance on shaping the project, led interview discussions, and
helped with writing and editing the paper. Apoorva Singh contributed to the secondary research for
this project.

The authors would like to thank Kylie Cherco for providing her valuable insights, sourcing additional
research, and facilitating the interview process.

The authors would also like to thank Bill Fera, Samir Hans, Michael Koppelmann, Derek Snaidauf,
Darin Srivisal, Jimmy Joseph, Neil White, George Van Antwerp, David Jarvis, Sayantani
Mazumder, Wendy Gerhardt, Regina DeSantis, Ramani Moses, Kim Cordes, Laura DeSimio, and
the many others who contributed their ideas and insights to this project.

About the authors

Kumar Chebrolu | [email protected]

Kumar Chebrolu is a managing director in Deloitte Consulting LLP’s Life Sciences and Health Care
practice. He leads Deloitte’s Applied AI and Digital Analytics practice for the health care sector, and his
work ranges from identifying growth opportunities, to implementing transformational programs,
building innovation capabilities, and creating disruptive products and services by leveraging artificial
intelligence/machine learning, expert decision support systems, digital analytics, and cloud computing.

Dan Ressler | [email protected]

Dan Ressler is the Life Sciences and Health Care leader for Global Risk Advisory and a principal in
Deloitte Risk and Financial Advisory’s Life Sciences practice, serving as the US Advisory Life Sciences
leader. With nearly 25 years of consulting experience in biopharmaceutical R&D, his expertise includes
capability strategy, complex delivery program leadership, tech integration, post-merger integration,
global operating model design, and internal/external sourcing strategies.

Hemnabh Varia | [email protected]

Hemnabh Varia is a senior analyst with Deloitte Services India Pvt Ltd, affiliated with the Deloitte Center
for Health Solutions. He has over seven years of experience in market research, competitive
intelligence, financial analysis, and research report writing. Varia holds a master’s degree in business
administration from Mumbai University.

16
 Smart use of artificial intelligence in health care: Seizing opportunities in patient care and business activities

Contact us
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Industry leadership

Kumar Chebrolu
Managing director | Deloitte Consulting LLP
+1 214 840 1578 | [email protected]

Kumar Chebrolu is a managing director in Deloitte Consulting LLP’s Life Sciences and Health Care
practice. He leads Deloitte’s Applied AI and Digital Analytics practice for the health care sector, and his
work ranges from identifying growth opportunities, to implementing transformational programs,
building innovation capabilities, and creating disruptive products and services by leveraging artificial
intelligence/machine learning, expert decision support systems, digital analytics, and cloud computing.

Bill Fera, MD
Principal | Deloitte Consulting LLP
+1 412 338 7500 | [email protected]

Bill Fera, MD, is a principal at Deloitte Consulting LLP. Fera specializes in technology-enabled
transformation to support the advancement of population health strategies. As a practicing physician,
health system executive, and consultant, Fera has worked across health plans and health systems to
drive toward a value-based, patient-centered model of care.

Kylie Cherco
Manager | Deloitte Consulting LLP
[email protected]

Kylie Cherco is a manager in Deloitte Consulting’s LLP’s Analytics and Cognitive practice. Her work
focuses on enabling health care organizations to strategically utilize data, analytics, and artificial
intelligence to gain deep, actionable insights on their members and develop personalized solutions to
improve consumer experience.

Industry center contact

Sarah Thomas, MS
Managing director | Deloitte Center for Health Solutions | Deloitte Services LP
+1 202 220 2749 | [email protected]

Sarah Thomas is the executive director of the Deloitte Center for Health Solutions, the Life Sciences
and Health Care practice’s primary source for thought leadership and industry insights. The center’s
research agenda is designed to inform and engage industry stakeholders, as Thomas aims to spark
meaningful dialog and continuous two-way learning.

17
About the Deloitte Center for Health Solutions

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