Revel CEO, Jeff Fritz co-presented with Chris Westphal, Director, Clinical Business Integrity and Solutions for UnitedHealthcare, at the 8th Annual Star Ratings Master Class in San Diego. The presentation provides a deep dive into the topic of using data analytics, AI and NLP for improvement health engagement, and ultimately driving better Star Ratings.

The following post is a summary of the information presented at the 8th Annual Star Ratings Master Class.

“We tend to overestimate the effect of a technology in the short run and underestimate the effect in the long run.”

Roy Amara

American researcher, scientist, futurist and former President of the Institute for the Future

Artificial intelligence (AI) may be one of the most promising areas of technology for driving better health engagement and higher Star ratings. But plans and providers may have a way to go before they can begin to see real benefits in terms of stronger engagement and better Star ratings. Remember that healthcare organizations typically have a lot of disparate systems that create disparate sets of data.UnitedHealthcare, for example, has worked hard to create systems that include large amounts of data sets in one place, critical for leveraging data more effectively.

“Creating a data-driven culture means breaking down the silos of information between operations, to bring all these sources of data together.”

Chris Westphal

Director, Clinical Business Integrity and Solutions for UnitedHealthcare

“For UnitedHealthcare, focusing on data as a critical success factor has had a significant impact on Star ratings for their plans,” says Chris Westphal. “Optum Labs is a good example where this focus has made significant strides toward better Star ratings. We’re excited to see more and more healthcare organizations out there making this commitment and it’s benefitting the entire industry.”

Both Westphal and Fritz agree that once data management has been addressed effectively, plans and providers can begin to address the potential of AI, and specifically Natural Language Processing, or NLP. NLP is the art of using computers to interpret sentences and phrases. Historically NLP within healthcare (and other industries) has focused on WHAT words are being said.

But to really gain the value of this technology, it’s important to focus also on HOW the words are said.Obviously, in a situation where a patient’s health may be on the line, subtle changes in what we call the sonic profile – the tone, enunciation, pitch, emotion and patterns – of the person responding can mean significant differences in how that member or patient moves through the decision tree of a provider’s system. But there are other, more subtle implications of using NLP that can improve member engagement.

The ability to focus not only on the WHAT but also the HOW in terms of language is technology that already exists.For example, patterns can be particularly helpful.

“Consider the speech changes that occur when someone is having a stroke, for example, or that a person with Parkinson’s might exhibit,” says Jeff Fritz.

“Without going too far down the rabbit hole in terms of describing the functions of AI’s neural networks, let’s just say that there are some incredibly exciting possibilities for this technology to significantly improve our engagement with patients and plan members.”

Jeff Fritz

CEO, Revel Health

Which leads us back to the main point of focus for any healthcare organization when it comes to engagement. We must ensure our interactions are humanized, whether they occur in person or via intelligent systems.

Improving the member experience and higher Star ratings will occur when trust is established, digitally or otherwise. A data-driven healthcare culture, and optimal use of technologies like AI should be part of your strategy in 2018. But we can never forget that the ultimate focus should always be on the person.

Chris Westphal and Jeff Fritz will present Artificial Intelligence, and Analytics for Star Rating Success at 9:30am Pacific Time at The 8th Annual Star Ratings Master Class, an intensive course in the latest in quality improvement strategies, presented by Healthcare Education Associates and RISE.

View the presentation here:

Data, AI and Analytics for Star Rating Success from Jeff L Fritz