Generative AI for Utilization Management

Healthcare organizations are under constant pressure to maximize operational efficiency and resource utilization while minimizing costs and improving patient care. Our generative AI model has been trained on over 40 million patients health histories and can be used to identify when additional utilization is helpful for a patient’s, and when it is and wasteful. It can further help identify areas for cost reduction, such as reducing readmissions or optimizing staffing levels.

How GenHealth helps

For example, our model can be used to identify the expected number of bad days or length of stay at a hospital. That can be prompted to adjust the expected outcome based on the patient's current situation. The model can play out the future of that patient under an earlier or later, discharge and identify, the most likely outcomes and likelihood of readmission or total cost. These predictions are based off the evidence from tens of millions of patients across the United States. Health plans can use this to more appropriately guide payment and authorization. Provider organizations can use this to determine the efficacy of longer stays and help negotiate for additional care.

The use of AI in operational efficiency and resource utilization has the potential to reduce healthcare costs, improve patient outcomes, and increase organizational efficiency. By leveraging AI to identify inefficiencies and optimize resource utilization, healthcare organizations can reduce waste and allocate resources more effectively.