Virtual care navigation platform Pager Health has built three new enterprise tools using Google Cloud generative AI technology to better support its payer partners.
Its care teams will have access to chat summation, a frequently asked questions bot and sentiment analysis.
The chat summation tool summarizes interactions with members, providing notes and eliminating documentation for clinicians.
"If an encounter takes 10 to 15 minutes, there's always five to 10 minutes of documentation time that person has to do in another system of record," said Nick D'Addezio, vice president of strategy and business development at Pager and a former executive director at Blue Cross Blue Shield Association. "In the chat summation tool, it goes down to one minute."
This time saved allows clinicians to focus on less administrative tasks and more "human" work. After all, there are about one million doctors in the U.S. to care for more than 300 million people. But with more efficiency comes questions as to whether the tools will be used as justification for payers to eliminate staff in the name of productivity.
Its FAQ bot, built on Google Dialogflow further reduces call center encounters, designed to augment responses based on on common health and benefit questions.
Finally, the sentiment analysis, powered by Google Vertex AI, assesses a member's emotional state and how an interaction progresses. It looks at chat responses including word choice, tone and speed of answer to determine if a member is happy, frustrated or anxious. This data is given back to payers so they can train their staff and optimize interactions. One day, this tool may trigger suggested responses within the platform based on common interactions, said D'Addezio.
Pager announced its partnership last year with Google Cloud to become one of the tech giant's 40 healthcare independent software ventures. Google recognized the growth potential of Pager as its platform grew in popularity during the pandemic. The company is also experimenting with using Med-PaLM 2, a large language model geared toward the medical space.
Pager has preferred Google to other AI companies because of Google's ability to tune models to specific client data instead of having data leak back into the general dataset to inform the foundational model, giving payers a greater sense of security.
The company works primarily works with 10 Blue Cross Blue Shield plans and major insurers in Latin America, and Pager is also in discussion with other national plans. D'Addezio believes that the new tools may provide capabilities to operate within more direct more provider models.
The implications of dramatically effective administrative tools strikes a tone heard before in the health tech space. Though efficiency is coveted by payers, providers and employees, what does that mean for the impacted call center staff and other employees?
"We have heard from some payers that for every dollar saved in medical cost, they would take 50 cents on the admin side," said D'Addezio.
These plans are required to meet medical loss ratio floors, meaning new efficiencies and cost savings on the admin side are valuable.
Administrative savings include staff overhead, call center staffing and selling, general and administrative expenses. Insurers must spend a certain percentage of revenues on improving care or they are subject to paying refunds.
Blue Cross Blue Shield Companies recorded a collective $7.5 billion in net income during the first half of 2023, a Fitch Ratings report revealed.
Pager sees AI tools as solutions that will supercharge productivity. Clinicians, call center agents, care managers, and specialists alike will be given access to "superpowers" to manage better manage patients.
"What we're trying to do is allow the existing staff to do more with essentially the same," said D'Addezio. "A lot of these payers are very strapped for administrative costs right now. It's basically upon the payer to decide how they look at their staffing mix."