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封面
市场调查报告书
商品编码
1620272

2024-2029 年全球付款人和提供者 IT 转型中的生成式 AI

Generative AI in Payer and Provider IT Transformation, Global, 2024-2029
出版日期: | 出版商: Frost & Sullivan | 英文 109 Pages | 商品交期: 最快1-2个工作天内

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简介目录

随着组织从识别转向实施，基于生成式人工智慧的解决方案正在推动整个付款人和提供者生态系统的变革性成长。

医疗保健产业正在整个价值链中逐步采用生成式AI（Gen AI）解决方案。几乎所有组织都表示有意将基于人工智慧的解决方案实施到其产品和流程中，而许多组织已经走上了这条道路。 Gen AI 与现有工具/IT 应用程式和其他技术解决方案无缝同步，以增强工作流程或建立新流程。付款人和提供者组织在提供全面和及时的患者照护方面面临着管理、营运、临床（仅限提供者）和财务挑战。这些问题通常会导致护理和后续观察的延误，影响消费者的整体健康。该行业正在从识别阶段转向实施阶段，关键采用案例将 Gen AI 解决方案用于各种用例，并与供应商合作微调输出。这在技术供应商和最终用户之间创建了一个新的生态系统，使领导者能够使技术采用与其组织的愿景和价值观保持一致。

由于技术和医疗资料的性质，方面和使用案例受到监管机构更严格的控制。这导致管理、营运和财务类别的产品开发和实施加速，但临床解决方案的成长有限。随着全球法规环境转向平衡创新与安全，政府、监管机构、技术开发人员和最终用户必须共同努力，为国家和组织制定管治模式。

考虑到技术和监管的发展，申请研究包括互通性和后勤部门等横向功能，我们正在寻求量化透过在利害关係人价值链最紧迫的部分部署基于人工智慧的解决方案所获得的节省（相关人员管理） ）和提供者（财务、业务、CDSS、文件、管理、病人参与）。本报告描述了这些使用案例中的技术进步，并重点介绍了一些利用 Gen AI 技术优化其产品组合的领先供应商。

涵盖北美（加拿大和美国）、欧洲、亚太地区以及亚太地区其他地区（拉丁美洲和加勒比地区、中东和非洲）采用基于 Gen AI 的解决方案。北美由于技术成熟度高、监管政策宽鬆、创业环境良好，在市场开发和招聘方面占据主导地位。北美地区继续成长最快，并透过采用基于 Gen AI 的解决方案节省大部分成本，而亚太地区的成长速度超过世界其他地区，到预测结束时其净收入将达到与欧洲相同的水平我认为会的。

GenAI 正在将更多相关人员带入该领域。如果实施得当并符合监管指导，它有可能解决行业最紧迫的挑战，并创造机会，到 2029 年在整个病人历程中产生超过 3000 亿美元的收益。

目录

分析范围和细分

  • 分析范围
  • 分割

成长环境：在支付方和供应商的 IT 转型中转变生成式 AI

  • 为什么成长如此困难？
  • The Strategic Imperative 8（TM）
  • 三大策略重点对在 IT 转型产业中利用生成式人工智慧对付款人和提供者的影响

用于付款人和提供者 IT 转型的生成式 AI 生态系统

  • 医疗保健相关人员之旅
  • 医疗服务提供者面临的主要挑战：在数位转型过程中，在不影响照护品质的情况下管理员工的担忧
  • 付款人面临的挑战 在应对不断变化的法规的同时平衡医疗保健成本和患者满意度
  • 关键问题如何影响工作流程和相关人员
  • 不断变化的监管环境
  • 监理与管治主要企业的作用
  • 客户声音影响与人工智慧生成的采用
  • 支持技术进步的发展生态系统
  • 使用案例开发和好处
  • Gen AI技术的演变
  • 使用案例采用层级的变化
  • 受益于基于 Gen AI 的解决方案
  • 自动化之旅
  • 技术采用之路
  • 人工智慧世代：生产力范式
  • AI世代利润的重新分配
  • 解决购买行为的关键市场区隔
  • 竞争环境
  • 供应商生态系统
  • 六角软体
  • 考多克斯
  • 微软
  • 威科健康
  • 密码健康
  • 系统间
  • 销售团队
  • 帕洛阿尔托网络
  • AKASA

付款人和提供者 IT 转型中的生成式 AI 成长产生器

  • 成长指标
  • 生长促进因子
  • 成长阻碍因素
  • 预测考虑因素
  • 调查方法
  • 收益预测
  • 各行业收益预测
  • 地区收益预测
  • 收益预测分析
  • 价格趋势和预测分析
  • 市场竞争结构
  • 收益占有率分析

成长动力：付款人 IT 转型

  • 成长指标
  • 收益预测
  • 按应用分類的收益预测
  • 地区收益预测
  • 预测分析
  • Gen AI的作用：风险调整
  • Gen AI 角色：相关人员管理
  • Gen AI 角色：支付完整性（索赔管理的一部分）
  • Gen AI 促进 Irrevance Health 会员参与
  • 蓝十字蓝盾协会 (BCBSA)

成长动力：提供者 IT 转型

  • 成长指标
  • 收益预测
  • 按应用分類的收益预测
  • 地区收益预测
  • 预测分析
  • AI世代的角色：金融（RCM）
  • Gen AI 的角色：营运
  • Gen AI 的作用：临床记录
  • Gen AI 的角色：临床决策支持
  • Gen AI 的作用：病人参与
  • 梅奥诊所
  • Kaiser Permanente 和 HCA Healthcare：不同的记录方法

成长动力：横向解决方案

  • 成长指标
  • 收益和预测
  • 按应用分類的收益预测
  • 地区收益预测
  • 预测分析
  • Gen AI 的作用：互通性
  • AI世代的角色：网路安全

在付款人和提供者的 IT 转型中使用 LLM 的成长机会

  • 成长机会1：在照护现场推广临床决策支援系统（CDSS）以实现个人化护理
  • 成长机会 2：减少与事先核准相关的行政负担
  • 成长机会 3：提高医疗资料互通性
  • 成长机会4：家庭医院（HaH）模式扩张的资源最佳化
  • 成长机会 5：加强病患和会员的参与

下一步

  • 成长机会的好处和影响
  • 下一步
  • 附件清单
  • 免责声明
简介目录
Product Code: KABD-48

Gen AI-based Solutions are Driving Transformational Growth across the Payer and Provider Ecosystem as Organizations Move from Identification to Implementation

The healthcare payer and provider industry is gradually adopting generative artificial intelligence (Gen AI) solutions across its value chain. Almost all organizations have shown an intent to implement Gen AI-based solutions in their products or processes, with a few already embarking on this journey. Gen AI seamlessly syncs with existing tools/IT applications and other technical solutions to enhance workflows or create new processes. Payer and provider organizations face administrative, operational, clinical (only providers) and financial challenges in delivering comprehensive and timely patient care. These issues often result in care delays and follow-ups, impacting the overall health of consumers. The industry is shifting from an identification to an implementation stage, with leading adopters using Gen AI solutions across different use cases and working with vendors to fine-tune output. This has created new ecosystems between technology vendors and end users that enable leaders to align technology adoption with an organization's vision and values.

Given the nature of technology and healthcare data, some aspects or use cases are more strongly governed by regulators than others. This has accelerated product development and adoption in the administrative, operational and financial categories while limiting the growth of clinical solutions. With the change in the global regulatory environment to balance innovation with safety, government, regulators, technology developers, and end users will need to work together to build national and organizational governance models.

. Looking at the evolving landscape of technology and regulations, this study seeks to quantify the savings that can be derived from implementing Gen AI-based solutions across some of the most pressing segments of the payer (claims management, risk adjustment, front- and back-office integration, marketing, and stakeholder management) and provider (financial, operational, CDSS, documentation, administrative, and patient engagement) value chains, including horizontal capabilities such as interoperability and cybersecurity. The report discusses technology advances made across these use cases and profiles several leading vendors optimizing their portfolios with Gen AI technology.

It covers the adoption of Gen AI-based solutions in North America (Canada and the United States), Europe, Asia-Pacific, and the rest of the world nations (Latin America and the Caribbean, Middle East, and Africa). North America dominates the market in terms of development and adoption owing to the region's higher technology maturity, less stringent regulatory policies, and favorable start-up environment. While North America will continue to be the fastest growing and generate the bulk of savings from the adoption of Gen AI-based solutions, growth in Asia-Pacific will outpace the remaining regions and its net gains will reach the same level as Europe by the end of the forecast period.

GenAI is attracting more stakeholders into its realm. If implemented thoughtfully and in line with regulatory guidance, it has the potential to address the most pressing industry challenges and create an opportunity to generate more than $300 billion in gains across the patient journey by 2029.

Table of Contents

Scope and Segmentation

  • Scope of Analysis
  • Segmentation

Growth Environment: Transformation in Generative AI in Payer and Provider IT Transformation

  • Why Is It Increasingly Difficult to Grow?
  • The Strategic Imperative 8™
  • The Impact of the Top 3 Strategic Imperatives on the Use of Gen AI in the Payer and Provider IT Transformation Industry

Ecosystem in Generative AI in Payer and Provider IT Transformation

  • Healthcare Stakeholder's Journey
  • Key Challenge for Providers: Managing Staff Concerns Without Compromising the Quality of Care During Digital Transformation
  • Key Challenge for Payers: Balancing the Cost of Care with Member Satisfaction while Staying on Top of Evolving Regulations
  • Impact of Key Challenges on Workflows and Stakeholders
  • Evolving Regulatory Landscape
  • Regulatory and Governance: Role of Key Players
  • Voice of the Customer: Gen AI Impact and Implementation
  • Development Ecosystem to Support Technology Progress
  • Use Case Development and Gains
  • Gen AI Technology Evolution
  • Changes in Use Case Adoption Level
  • Deriving Gains from Gen AI-based Solutions
  • Automation Journey
  • Path to Technology Deployment
  • Gen AI: Productivity Paradigm
  • Redistributing Gains from Gen AI
  • Key Market Segmentation to Address Buying Behavior
  • Competitive Environment
  • Vendor Ecosystem
  • Hexaware
  • Codoxo
  • Microsoft
  • Wolters Kluwer Health
  • Cipher Health
  • InterSystems
  • Salesforce
  • Palo Alto Networks
  • AKASA

Growth Generator in Generative AI in Payer and Provider IT Transformation

  • Growth Metrics
  • Growth Drivers
  • Growth Restraints
  • Forecast Considerations
  • Forecast Methodology
  • Revenue Forecast
  • Revenue Forecast by Industry Vertical
  • Revenue Forecast by Region
  • Revenue Forecast Analysis
  • Pricing Trends and Forecast Analysis
  • Competitive Market Structure
  • Revenue Share Analysis

Growth Generator: Payer IT Transformation

  • Growth Metrics
  • Revenue Forecast
  • Revenue Forecast by Application
  • Revenue Forecast by Region
  • Forecast Analysis
  • Role of Gen AI: Risk Adjustment
  • Role of Gen AI: Stakeholder Management
  • Role of Gen AI: Payment Integrity (Part of Claims Management)
  • Elevance Health: Gen AI for Member Engagement
  • Blue Cross Blue Shield Association (BCBSA)

Growth Generator: Provider IT Transformation

  • Growth Metrics
  • Revenue Forecast
  • Revenue Forecast by Application
  • Revenue Forecast by Region
  • Forecast Analysis
  • Role of Gen AI: Financial (RCM)
  • Role of Gen AI: Operational
  • Role of Gen AI: Clinical Documentation
  • Role of Gen AI: Clinical Decision Support
  • Role of Gen AI: Patient Engagement
  • Mayo Clinic
  • Kaiser Permanente and HCA Healthcare: Different Approaches to Documentation

Growth Generator: Horizontal Solutions

  • Growth Metrics
  • Revenue Forecast
  • Revenue Forecast by Application
  • Revenue Forecast by Region
  • Forecast Analysis
  • Role of Gen AI: Interoperability
  • Role of Gen AI: Cybersecurity

Growth Opportunity Universe in the Use of LLMs for Payer and Provider IT Transformation

  • Growth Opportunity 1: Promote Clinical Decision Support System (CDSS) at Point-of-care for Personalized Care
  • Growth Opportunity 2: Reduce Administrative Burden Associated with Prior Authorization
  • Growth Opportunity 3: Improve Healthcare Data Interoperability
  • Growth Opportunity 4: Optimize Resources for Expansion of the Hospital at Home (HaH) Model
  • Growth Opportunity 5: Enhance Patient and Member Engagement

Next Steps

  • Benefits and Impacts of Growth Opportunities
  • Next Steps
  • List of Exhibits
  • Legal Disclaimer