We are often asked at Healthily, 'What sets you apart?' The answer is simple, our approach to solving a problem.
By Jonathan Carr Brown, Managing Director at Healthily
Many global health insurers have adopted first-generation AI Health Navigation systems, which lack the depth of data and medical expertise required to make a difference for their members. With a basic system the impact on users can be negligible – and sometimes damaging.
It's no wonder there's scepticism about AI.
Signposting with confidence
A common problem with AI navigators based on symptom checkers is that they tend to be ultra-conservative. Nobody wants a solution so risk-averse that it directs more people, not fewer, to scarce clinical resources. Nor do they want a solution that frustrates consumers, leading them to abandon it after a single use. Finding the right balance between risk and value is hard, particularly when dealing with people’s healthcare choices.
In a recent article, we outlined the 3 types of problematic appointments eroding health insurance margins:
Unnecessary Pathways: members booking appointments for ailments that could be managed with self-care or for minor issues;
Inefficient Pathways: members consulting generalists instead of allied health professionals such as physiotherapists;
Duplicate Pathways: teleconsultations that immediately lead to face-to-face visits as they require a physical examination (blood pressure, auscultations, etc).
This analysis underscores the challenges facing health insurers.
While AI presents a solution, it's only part of the equation. After 9 years of experience, including extensive user testing, we've found that changing healthcare demand hinges primarily on behavior change, not just technology. This seems to be the ‘smoking gun’ for the failed attempts by a few organizations to introduce AI navigation for members’ choices.
Understanding user health choices
As Steve Martin, managing director of Influence at Work and a leading expert in behavioral science teaches, when we are asking people to change we have to ask:
Do they have the ability to change?
Is the change what they would want to do?
Is the change aligned with fundamental human motivations?
Health-seeking behavior is complex, often driven by anxiety, knowledge disparities and a desire for immediate relief. Unlike other industries, such as banking or shopping, navigating healthcare requires a nuanced approach as one size does not fit all.
Many of the people who are asked to change can’t change because they are burdened by anxiety, discomfort or pain. The change required is not what they want because it appears to prolong their anxiety, discomfort and pain. Therefore it shouldn’t surprise anyone that there’s little motivation to move from: ‘I want to see a doctor’ to ‘Yes, I probably can self-care’; ‘Yes, it might be better to see a physiotherapist before a doctor’; or ‘Yes, a virtual consultation with a nurse will reassure me as much as one with a doctor.’
3 Categories of health-seeking behavior
To understand health-seeking behavior better we've identified 3 broad categories of personas: Do Knows, Don't Knows, and Task Seekers, further divided into 17 sub-categories. Each category requires tailored pathways to address Unnecessary, Inefficient, and Duplicate appointments effectively.
For instance, those who already know their condition (Do Knows) won’t benefit from a symptom checker telling them what they already know. In this case, Healthily focuses on offering users a pre-consultation assessment, to streamline their visit so they can get to the right ‘endpoint’ quicker.
Similarly, those seeking sick notes or specific tests (Task Seekers) can be guided to the most appropriate and speediest pathway – again using AI to assist in verifying and selecting the most relevant next steps.
For those users who are not sure about what they need (Don’t Knows), AI can help them better understand their situation and triage them to the recommended best course of action instead of showing a list of probable illnesses (as users can’t tell the difference!).
Tailored AI-powered solutions
Healthily’s Dot™ platform stands out for its ability to navigate healthcare choices based on personal risk and appropriateness at a service level. It offers tailored solutions to optimize resource allocation and improve patient outcomes in a fully automated manner, without human intervention.
Dot™ has been developed to answer a very specific question: 'What should I do?' rather than 'What’s wrong with me?'. Doctors can’t be replaced by AI (even in the medium to long term) but automation can deliver enormous value (safely) around navigation and triage, leaving the task of diagnosing to healthcare professionals – which is what they do best.
For this reason, we believe that AI can play a crucial role in shaping and optimizing users’ behavior when it comes to healthcare choices.
Embrace the future of healthcare efficiency with us. Explore how AI-powered solutions from Healthily can transform your organization's approach to appointment management and resource allocation. Together, let's build a healthier, streamlined, and cost-effective healthcare ecosystem.
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