Chatbots may help save healthcare in the coming decade

While it might have seemed like science fiction a few years ago, today we live in a world where an intelligent, conversational machine could save your life, and chatbots may save many more in the coming decades. Autonomous conversational interfaces between humans and smart machines are having positive impacts on mental healthdrug adherence, and many other areas of healthcare, as you can read in our extensive guide to this technology. While this new technology is impressive, major forces at play in the healthcare industry will necessitate innovative new approaches to using chatbots to meet the growing demands.

Existing methods in healthcare are already strained under the demand for patient engagement, and the growing numbers of seniors requiring care. The shift to value-based care, new readmission requirements, and a rapidly growing number of Medicaid beneficiary enrollments will only increase that demand, requiring innovative new solutions to this growing problem. These forces will require more work across a longer timeframe to deliver healthcare to more sick people. When we look closely at these forces in healthcare, we can see that the powerful new technology of chatbots can play a large role in addressing this serious problem. These powerful autonomous conversational agents—software capable of having text and audio conversations with people—may be just what the healthcare industry needs.

Population Health

One major pressure on the healthcare system has been brought about by the sharing of risk between payers and providers, generally referred to as population health. This new value-based care payment model requires providers to manage the overall health of their patients, not simply to treat them when they present with medical problems.

While better for patients, the population health approach puts considerable strain on healthcare providers. Providers must track items such as annual visits, immunizations, and preventative procedures like mammograms and colonoscopies. Reaching out to patients and scheduling these visits when necessary is a huge task. Failing to complete and track these measures reduces the amount of money that providers receive, which exacerbates the problem by leaving less money to accomplish the increased amount of clinical work. So, the first factor—the population health model—requires providers to do more work.

Expanded Timeframe

Another major pressure on the medical system comes from the expanded timeframe of care for inpatient services. Before 2010, an inpatient episode was simply the services rendered between the date of admission and the date of discharge. After 2010, the episode timeframe was expanded to three days prior to the admission date. One reason for this extension was to limit reimbursement for any pre-hospitalization testing that was being paid separately under outpatient billing. For example, if expensive radiological tests are needed prior to the inpatient treatment, those are now covered under the inpatient reimbursement.

Starting in 2015, the timeframe for care was also extended on the discharge side. Medicare and many other payers began applying readmission penalties if a patient returned to any facility within 30 days. The proposed logic was simple (and simplistic)—if patients were properly treated for their condition and stabilized, they would not need to return to a hospital. If medical professionals make patients healthy the first time, then they won’t need to return… another push toward value-based care that emphasizes quality of care.

These two changes may have been good for patients, but they create more work for healthcare professionals since they essentially expand the timeframe of a hospitalization on both sides of admission and discharge. A “visit” to the hospital now ostensibly lasts 3 days before the visit through 30 days after the end of the hospitalization, requiring hospitals to deliver more and better care across a longer timeframe for less money.

Booming Demographics

The third major force in healthcare markets comes with the aging of the baby boomer generation. This large group will require more healthcare resources as they age, having a huge impact on Medicare. In 2015 there were 55 million Medicare enrollees. By 2050, that number is estimated to become 77 million, an increase of 40%. Because this rapidly growing segment of the population uses the most provider visits and impatient hospitalization, the aging boomer generation is expected to place a major strain on the healthcare system. After all, “demographics is destiny”.  Ultimately, there are going to be more people who need care.

The Problem Reconsidered

Taken together, these factors impacting healthcare providers can be summarized as more work across a longer timeframe delivered to more people, specifically older people. A recent study showed that people aged 70 and older accounted for 66% of all Medicare spending in 2011. Of this, 33% was for people aged 80 and older, a segment of the population that will quadruple by 2050

Adding all of these factors together, it becomes clear that the scope of the issues facing the healthcare industry is immense. Simply expanding the number of healthcare workers and facilities to accomplish person-to-person interactions in hospitals or other provider offices just can’t meet the need. The American healthcare costs will exceed the revenue generated.

New processes and technologies must be applied to this problem, and thankfully there is a wide range of exciting emerging technologies that are tackling a variety of problems. Chatbots are especially well positioned to have a direct positive impact on these specific factors significantly affecting healthcare, now and in the coming decades. There is an urgent need to deploy chatbot solutions to address the specific problems of more work across a longer timeframe delivered to more people. Thankfully, chatbots appear to be up to the task.

The Chatbot Solution

Conversational agents are already helping provider offices with the population health task of scheduling immunizations. For example, SimplifiMed has developed a chatbot that is helping providers engage their patients via text conversations to schedule annual checkups and flu and pneumonia vaccinations. Better yet, the chatbot can select an appointment time that fits the patient’s and provider’s schedules, which is then automatically placed in the patient management schedule. 

One office, Swenson Premier Care (a single-provider practice in Scottsdale, AZ), has already seen amazing response rates using SimplifiMed. Previously, the office was making person-to-person telephone calls, and mostly leaving voicemail messages. After shifting to chatbot technology, the response rate in the first 60 seconds after patients received the bot’s message was 30%, up from the 1% response rate for postcards and phone calls. Clearly, chatbots can have a major impact on the new challenges faced by large and small healthcare facilities.

As we know, the window for contact between patient and provider is being extended even as providers are financially pushed to discharge patients sooner and send them home to recover fully. This reduction in daily face-to-face contact may soon leave some recently hospitalized patients without hourly or daily contact with healthcare professionals to answer questions and identify risks. This lack of direct contact and conversation may lead to readmissions when problems in the recovery process escalate—problems that could be mediated and addressed with chatbots.

With the proper AI-powered scripts, a chatbot is able to help reduce the risk of patient readmission. Another early leader in the use of chatbots in healthcare is Conversa. Conversa has developed and deployed chatbots to reduce readmissions, as well as for many other population-health measures. Their technology has integration hooks to over 400 biometric devices and patient-generated data. Data from the devices and conversations between the patient and chatbot help case managers and care coordinators determine who is progressing smoothly and who needs a phone call. Chatbots have the power to direct care to the patients that are most in need of attention, thereby reducing readmissions.

With the proper AI-powered scripts, a chatbot is able to help reduce the risk of patient readmission. Another early leader in the use of chatbots in healthcare is Conversa. Conversa has developed and deployed chatbots to reduce readmissions, as well as for many other population-health measures. Their technology has integration hooks to over 400 biometric devices and patient-generated data. Data from the devices and conversations between the patient and chatbot help case managers and care coordinators determine who is progressing smoothly and who needs a phone call. Chatbots have the power to direct care to the patients that are most in need of attention, thereby reducing readmissions.

The traditional method of postcards, robocalls, and expensive personal calls is already unable to effectively reach the 55 million Medicare patients in need of extended care. When that number grows by 40%, as it is expected to do by 2050, health professionals will be faced with delivering quality care to 77 million people—a task that seems unfathomable. Looking at the math, the numbers aren’t good. In 2015 there were 10 million Medicaid inpatient admissions. If the traditional phone calls were made to these patients every three days for the 30 days following discharge, that adds up to 100 million calls. If each full-time employee made 24,480 five-minute calls each year, this would still require 20,425 employees. And that number explodes when you add outpatient visits and the rising numbers of Medicaid patients. It is apparent that traditional methods are just not feasible to meet the needs of the increasing numbers of Medicare patients. The beauty of chatbots, however, is that they can be created today and scaled to the demands of the future.

Beyond handling phone calls and check-ins, chatbots have tremendous power to make the work of healthcare professionals more efficient and effective. By creating chatbot personal assistants for healthcare providers and support staff, the productivity of the entire healthcare workforce can be increased, and they can be engaged more effectively. Our Guide to Chatbots (link) details how this new technology can transform the efficiency and effectiveness of healthcare professionals and patient engagement.

Check out our Guide to Chatbots

Learn more about the basics of chatbot tech and find innovative companies transforming the industry.

Wrapping Up

There are significant market forces at work in healthcare, and many changes are anticipated in the coming decades. We should expect and hope that more efforts will be made to expand care coverage and the standards of quality care so that we can all achieve the grand mission of healthcare: treating sick people with the dignity, care, and follow-up they need to heal and become well again. The changes expected for providers, however—more work across a longer timeframe helping more people—require that we implement technologies like chatbots to effectively deal with the problem. Old methods will need to be redesigned with scalable and automated solutions. Chatbots are a strong candidate to address these problems. This emerging technology has proven itself in e-commerce; now it’s time to apply chatbots in healthcare to solve some of these pressing challenges.

Author: John Ulett

John Ulett is the VP at Toehold Learning. He has over thirty years experience working with innovations in software technology, and eighteen spent in the healthcare industry. John’s experience provide him a unique perspective on the challenges of integrating new technologies into the framework of existing healthcare technologies.

Leave a Comment

Your email address will not be published. Required fields are marked *

This site uses Akismet to reduce spam. Learn how your comment data is processed.

Scroll to Top
%d bloggers like this: