My career started in and continues to focus on healthcare. Every four years, healthcare organizations of all kinds hold their breath waiting to see exactly how the transition of power from one administration will impact their world. This past election was no different. Joe Biden’s inauguration last week marks a new direction for the country in just about every policy arena, but as a clinical AI company, we’re most interested in the changes coming for healthcare.
From getting the pandemic under control to accelerating the shift to value-based care, Biden and his team have given us a taste of what to expect in the new administration. Let’s break down a few of the major policy priorities and how clinical AI can play a role in each:
The new administration is already moving quickly to step up the federal government’s pandemic response, with executive orders invoking the Defense Production Act to increase the supply of vaccines, tests, and protective gear; setting up 100 community vaccination sites in 30 days; vaccinating 100 million Americans in 100 days; strengthening workplace safety enforcement and more.
Clinical AI can help make sure any increases in the vaccine supply are going to the people who need them most. Last week, we launched our Vaccination Prioritization Index (VPI) to identify the individuals and communities who should be prioritized for vaccination, based on CDC guidelines and our AI insights on the social determinants of health that make people more vulnerable. These insights can help make sure vaccines are distributed equitably to the populations hardest hit by the pandemic — a priority of the Biden administration.
Jvion’s publicly available Community Vulnerability Map, also includes a community level vaccination prioritization index which public health officials can use to target where they stand up mobile vaccine clinics, distribute vaccines and other medical supplies, and focus their community education efforts.
Advancing AI Development
Before he was elected, Biden proposed an increase in federal R&D spending to $300 billion over the next four years, boosting investment in technologies including 5G, biotechnology, clean vehicles, and — most relevant here — artificial intelligence.
Investing in these technologies will be critical to America’s competitiveness on the global stage. In the context of healthcare, increasing AI investment will improve care outcomes and lower costs by enabling health systems to deploy their resources more effectively.
As progressives and conservatives alike call for greater oversight on the tech sector, we can also anticipate more regulation for AI. Implemented correctly, these regulations could standardize performance evaluations, increase transparency and build trust among healthcare professionals, who are used to seeing the FDA stamp of approval for everything from drugs to medical devices. That said, any new regulations should be careful not to stifle innovation in AI.
The Affordable Care Act was a turning point for value-based care. As one of the architects of the law, President Biden and his administration will be sure to continue the trajectory of President Trump’s administration toward value-based care.
However, unlike his predecessor, experts believe Biden’s administration will focus on increasing participation in value-based models, rather than raising the performance standards of value-based models, which discouraged participation. Some have suggested that there could even be new payment models that pay providers to close disparities in outcomes along racial, gender, or geographic lines.
As more providers get involved, value-based reimbursement can provide financial stability, especially after fee-for-service revenue dried up when elective procedures and routine care were put on hold for much of last year. But it also puts the onus on providers to improve their patient outcomes, or risk facing financial penalties. This is where clinical AI comes in.
Clinical AI like the Jvion CORE™ can help providers change future outcomes by predicting avoidable adverse health outcomes, including unnecessary admissions, disease progression, and behavioral health events. Taking it one step further, the prescriptive side of Jvion’s analytics delivers prioritized next steps for care teams based on an individual’s clinical and socioeconomic needs. These insights enable the proactive, preventive care needed to make value-based care work.
This approach has been proven to work: value-based care provider The Center for Cancer and Blood Disorders in Texas saved $3 million after implementing the CORE, and one national health plan with 20 million members found that within a subpopulation of 500,000 members, Jvion could help save $7.5 million per year by preventing sepsis.
Health Insurance Coverage
One of Biden’s signature campaign promises was to build on the ACA and reduce the number of uninsured Americans. This is an urgent priority: around 14.6 million Americans lost their employer-sponsored health insurance during the pandemic last year as jobs were cut.
The Biden administration can take several approaches to expanding coverage. They could reopen the ACA enrollment period; lower the Medicare eligibility age; restore funding for healthcare.gov navigators, marketing and outreach; work with Congress to expand Medicaid to the states that have held out; and increase subsidies and tax credits for plans on the ACA marketplace. Biden also pledged to create a public option, but this will be unlikely with narrow control of Congress.
However, increasing the availability of affordable health coverage only helps if the people who would benefit from coverage enroll. This is critical not only for uninsured or underinsured patients, but also for healthcare providers, 48% of whom saw an increase in uncompensated care last year.
This is another area where prescriptive clinical AI can help: predicting which patients are likely to need acute care in the next six months and who would benefit from financial assistance or health plan enrollment services.
The next year will surely be a challenging one for healthcare organizations as they continue to balance surviving the impact of COVID on their communities and operations with the new regulatory environment. This is not the time for the industry to put the brakes on AI investment, on the contrary, it’s time to push the accelerator.