The Need for Real ROI

Providers continue to face revenue pressures and need to demand measurable performance from themselves, their partners, and their vendors.

This article first appeared in the September 2017 issue of HealthLeaders magazine.

At our Population Health Exchange, an invitation-only gathering of healthcare leaders this summer, an executive with one of the event sponsors commented to me that his takeaway from providers is their need for real ROI. They are focused on return on investment, he said, and will be pushing vendors for more explicit information in this area.

Certainly, Exchange members were circumspect regarding the financial implications of population health and other industry trends.

Providers continue to face revenue pressures, so they need to demand measurable performance from themselves, their partners, and their vendors. As the industry's care and reimbursement models are refocused on value, new technology—especially artificial intelligence—can play an important role. 

But after years of high-cost tech spending with sometimes-dubious bottom-line value, leaders need to be prudent—but not timid—when it comes to AI. 

"It's appropriate to be cautious. I certainly am," says Isaac Kohane, MD, PhD, in the cover story for the September HealthLeaders magazine.

But Kohane, Marion V. Nelson professor of biomedical informatics and chairman of the department of biomedical informatics at Harvard Medical School, says AI will be unlike the EHR experience. "This looks different. This will be adopted because it gives productivity and financial gain and accuracy right away when you implement it, as opposed to the promissory note around EHRs, which has not yet really shown itself to be robust." 

Some early adopters of healthcare AI are realizing improvement, but the adoption is controlled.

In our cover story, Todd Stewart, MD, vice president of clinical integrated solutions at St. Louis–based Mercy, explains that while an EHR rollout called for large up-front spending, AI investment can be done step-by-step, with a smaller financial outlay, and a focus on early results and learning.

At Mercy, which reported 2016 operating revenue of $5 billion, AI algorithms are tracking invoices and forecasting monthly inpatient and outpatient claims and collections. "We've gone from 70% forecasting accuracy to greater than 95% accuracy in a few weeks," says Stewart. He also estimates that improved insights through AI are creating savings of $14–$17 million tied to Mercy's clinical pathways in fiscal year 2016.

Stewart insists that AI investment is essential. "If you are not adept in this space, you are not going to be competitive in the very near future."  

Artificial intelligence holds the promise of unleashing the potential of data stored in electronic systems and offering insights to help leaders improve clinical and financial outcomes.

A renewed emphasis on real ROI will help leaders embrace the future while respecting the realities of today's challenging healthcare environment.