查看購物車
  • Simplified Chinese
  • English
  • Japanese
  • Korean
封面
市場調查報告書
商品編碼
1620272

2024-2029 年全球付款人和提供者 IT 轉型中的生成式 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個工作天內

價格
簡介目錄

隨著組織從識別轉向實施，基於生成式人工智慧的解決方案正在推動整個付款人和提供者生態系統的變革性成長。

醫療保健產業正在整個價值鏈中逐步採用生成式AI（Gen AI）解決方案。幾乎所有組織都表示有意將基於人工智慧的解決方案實施到其產品和流程中，而許多組織已經走上了這條道路。 Gen AI 與現有工具/IT 應用程式和其他技術解決方案無縫同步，以增強工作流程或建立新流程。付款人和提供者組織在提供全面和及時的患者照護方面面臨著管理、營運、臨床（僅限提供者）和財務挑戰。這些問題通常會導致護理和後續觀察的延誤，影響消費者的整體健康。該行業正在從識別階段轉向實施階段，關鍵採用案例將 Gen AI 解決方案用於各種用例，並與供應商合作微調輸出。這在技術供應商和最終用戶之間創建了一個新的生態系統，使領導者能夠使技術採用與其組織的願景和價值觀保持一致。

由於技術和醫療資料的性質，方面和使用案例受到監管機構更嚴格的控制。這導致管理、營運和財務類別的產品開發和實施加速，但臨床解決方案的成長有限。隨著全球法規環境轉向平衡創新與安全，政府、監管機構、技術開發人員和最終用戶必須共同努力，為國家和組織制定管治模式。

考慮到技術和監管的發展，申請研究包括互通性和後勤部門等橫向功能，我們正在尋求量化透過在利害關係人價值鏈最緊迫的部分部署基於人工智慧的解決方案所獲得的節省（相關人員管理） ）和提供者（財務、業務、CDSS、文件、管理、病人參與）。本報告描述了這些使用案例中的技術進步，並重點介紹了一些利用 Gen AI 技術最佳化其產品組合的領先供應商。

涵蓋北美（加拿大和美國）、歐洲、亞太地區以及亞太地區其他地區（拉丁美洲和加勒比地區、中東和非洲）採用基於 Gen AI 的解決方案。北美由於技術成熟度高、監管政策寬鬆、創業環境良好，在市場開發和招聘方面佔據主導地位。北美地區繼續成長最快，並透過採用基於 Gen AI 的解決方案節省大部分成本，而亞太地區的成長速度超過世界其他地區，到預測結束時其淨收入將達到與歐洲相同的水平我認為會的。

GenAI 正在將更多相關人員帶入該領域。如果實施得當並符合監管指導，它有可能解決行業最緊迫的挑戰，並創造機會，到 2029 年在整個病人歷程中產生超過 3000 億美元的收益。

目錄

分析範圍和細分

  • 分析範圍
  • 分割

成長環境：在支付方和供應商的 IT 轉型中轉變生成式 AI

  • 為什麼成長如此困難？
  • The Strategic Imperative 8（TM）
  • 三大策略重點對在 IT 轉型產業中利用生成式人工智慧對付款人和提供者的影響

用於付款人和提供者 IT 轉型的生成式 AI 生態系統

  • 醫療保健相關人員之旅
  • 醫療服務提供者面臨的主要挑戰：在數位轉型過程中，在不影響照護品質的情況下管理員工的擔憂
  • 付款人面臨的挑戰 在應對不斷變化的法規的同時平衡醫療保健成本和患者滿意度
  • 關鍵問題如何影響工作流程和相關人員
  • 不斷變化的監管環境
  • 監理與管治主要企業的作用
  • 客戶聲音影響與人工智慧生成的採用
  • 支持技術進步的發展生態系統
  • 使用案例開發和好處
  • Gen AI技術的演變
  • 使用案例採用層級的變化
  • 受益於基於 Gen AI 的解決方案
  • 自動化之旅
  • 技術採用之路
  • 人工智慧世代：生產力範式
  • AI世代利潤的重新分配
  • 解決購買行為的關鍵市場區隔
  • 競爭環境
  • 供應商生態系統
  • 六角軟體
  • 考多克斯
  • 微軟
  • 威科健康
  • 密碼健康
  • 系統間
  • 銷售團隊
  • 帕洛阿爾托網路
  • AKASA

付款人和提供者 IT 轉型中的生成式 AI 成長產生器

  • 成長指標
  • 生長促進因子
  • 成長阻礙因素
  • 預測考慮因素
  • 調查方法
  • 收益預測
  • 各行業收益預測
  • 地區收益預測
  • 收益預測分析
  • 價格趨勢和預測分析
  • 市場競爭結構
  • 收益佔有率分析

成長動力：付款人 IT 轉型

  • 成長指標
  • 收益預測
  • 按應用分類的收益預測
  • 地區收益預測
  • 預測分析
  • Gen AI的作用：風險調整
  • Gen AI 角色：相關人員管理
  • Gen AI 角色：支付完整性（索賠管理的一部分）
  • Gen AI 促進 Irrevance Health 會員參與
  • 藍十字藍盾協會 (BCBSA)

成長動力：提供者 IT 轉型

  • 成長指標
  • 收益預測
  • 按應用分類的收益預測
  • 地區收益預測
  • 預測分析
  • AI世代的角色：金融（RCM）
  • Gen AI 的角色：營運
  • Gen AI 的作用：臨床記錄
  • Gen AI 的角色：臨床決策支持
  • Gen AI 的作用：病人參與
  • 梅奧診所
  • Kaiser Permanente 和 HCA Healthcare：不同的記錄方法

成長動力：橫向解決方案

  • 成長指標
  • 收益和預測
  • 按應用分類的收益預測
  • 地區收益預測
  • 預測分析
  • Gen AI 的作用：互通性
  • AI世代的角色：網路安全

在付款人和提供者的 IT 轉型中使用 LLM 的成長機會

  • 成長機會1：在照護現場推廣臨床決策支援系統（CDSS）以實現個人化護理
  • 成長機會 2：減少與事先核准相關的行政負擔
  • 成長機會 3：提高醫療資料互通性
  • 成長機會4：家庭醫院（HaH）模式擴張的資源最佳化
  • 成長機會 5：加強病患和會員的參與

下一步

  • 成長機會的好處和影響
  • 下一步
  • 附件清單
  • 免責聲明
簡介目錄
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