AI Gets You Close, But It Takes Humans to Seal the Deal
Artificial Intelligence (AI) is transforming all industries, including healthcare, before our eyes. It is automating complex tasks and providing insights that would be impossible for humans to generate at scale. For example, health plans receive thousands of provider rosters each month. Even when health plans use traditional rules-based automation methodologies, the rosters still require substantial manual standardization and quality checks. For a large national plan, the turnaround time to process a roster was eight weeks. We have seen AI reduce this turnaround time to less than 48 hours. Results of this magnitude fuel fears about people losing their jobs. But here is the reality: AI is really good at predictable tasks, but when faced with a curveball, it sometimes drops the ball. Think of it like toothpaste that promises to kill 99.9% of germs—AI can kill 95% of germs, but that last 5%? Well, that’s where we humans step in with our trusty logic and common sense.
AI vs Human Brain
The fear that AI will take people’s jobs relies on the premise that AI can think, learn, and grow just as effectively as the human brain does. But that is not the case. AI is designed to recognize patterns, process vast amounts of data, and make decisions based on predefined algorithms. AI’s strength is handling repetitive, well-defined tasks where patterns can be identified and acted upon. That is why it is so effective at helping health plans ingest and standardize their incoming rosters. Regardless of the roster’s format, AI can identify where to locate relevant data in a file, read the information, and then identify errors.
Unlike the human brain which can adapt, reason, and innovate in the face of new challenges, AI struggles when it encounters something it hasn't seen before. When faced with new scenarios or edge cases, AI's performance drops. It’s like a GPS telling you to drive straight into a lake, because it doesn’t recognize that there’s construction ahead. Understanding these limitations is crucial to understand when considering AI’s role in our work and lives.
"Human over the Loop”
So, how should you approach working alongside AI? The best approach is to use AI to tackle the most common and repetitive cases. Using the roster process example, we use an approach called “human over the loop.” Simply put, the AI requests human feedback when it runs into a scenario in the incoming roster that it doesn’t recognize. For example, when standardizing provider roster files for health plans, the AI might encounter two columns with similar values and headings, such as provider identifier: NPI 1 and NPI 2. As a human, I can use contextual clues to determine that NPI 1 pertains to the provider that is offering care to the patient, since it is next to the provider’s name in the file. Meanwhile, NPI 2 likely pertains to the provider’s practice group, since it’s positioned near the group name In such cases, the AI would ask for human input to clarify the distinction. This feedback loop allows AI to learn and improve, while also ensuring that the decisions are accurate and contextually appropriate. As a result, we have seen a 90% automation rate with 95% accuracy in applying AI to the roster ingestion process. In short, we can balance efficiency and adaptability by combining AI with human expertise.
Setting the record straight
When someone claims that AI can solve everything or it is coming for our jobs, setting the record straight is imperative. While AI is a powerful tool, it is certainly not a replacement for all human jobs. The human brain’s ability to think creatively, make judgment calls, and adapt to new situations is irreplaceable. AI may be the future, but it still needs a little help from its human counterparts.
Reflecting on these trends, it’s clear that the provider data landscape is rapidly evolving. These trends will also become table stakes in a year. That is why to remain leaders in the industry, HiLabs establishes deep partnerships with health plans to solve complex problems. It is because of these very collaborations that HiLabs technology maintains its place as an industry thought leader and innovator.
If you are interested in learning more about our solutions contact us today.