Can AI Cure What Ails the Healthcare Industry?

Personal healthcare experiences often spark pioneering cures, and Hindsait CEO Pinaki Dasgupta is no exception. After two immediate family members weathered serious health issues, Dasgupta brought his digital expertise in manufacturing to the healthcare industry.

His cloud-based startup is designed to help insurance companies and healthcare organizations reduce costs while boosting patient health by replacing manual reporting, preauthorization, and audits with automation based on artificial intelligence (AI).

Healthcare spending in the U.S. alone has totaled almost 18 percent of the country’s gross domestic product (GDP), an astounding amount. While the causes are complex, Dasgupta points to unnecessary procedures, inefficiencies, errors, abuse, and fraud as among the top culprits. AI was just emerging when he founded Hindsait in 2013 amid a swirl of market-wide healthcare reform models.

“It was the perfect storm of technology advances, market changes, and my family’s deeply personal health experiences,” said Dasgupta. “With health-related companies capturing more information digitally, we were convinced AI data would revolutionize healthcare decision-making through evidence-based care.”

Cost-Savings from Greater Efficiencies and Fewer Mistakes

Based in the U.S., with offices in New Jersey and Massachusetts, Hindsait’s software as a service (SaaS) platform uses clinical natural language processing (NLP) to capture medical record information. Its robotics process automation (RPA) tool calculates treatment justification and factors in codes and clinical interventions. By automating 60 percent of preauthorization requests, the startup has demonstrated $18 million in cost-of-care savings. Hospitals and other healthcare providers have improved coding efficiencies by 90 percent and increased nursing efficiencies by 35 percent.

“We saw a huge opportunity to address avoidable healthcare spend and, in doing so, help transform the way organizations deliver and administer healthcare,” explained Dasgupta. “More accurate recordkeeping helps healthcare providers receive timely reimbursement, and insurance companies better manage reviews and billing audits during preauthorization and after approval. Automation reduces errors, helping companies make better decisions and pay the right amount.”

AI Automates Processes to Augment People

According to Dasgupta, the Hindsait team is the antithesis of the scariest misconceptions about what happens when adding AI to healthcare. A combination of physicians, nurses, data scientists, and business leaders work together to eliminate human error and bias in clinical decisions.

“We automate and augment human decision-making,” Dasgupta said. “Physicians and nurses work with our data scientists to look at the algorithms from a clinical perspective throughout the development process. We also conduct regular manual audits and reviews with our clinical team and our clients’ teams to make sure bad data doesn’t inadvertently bias our machine learning algorithms.”

The idea is to waste less time and rely on each person’s expertise.

“Our studies found that in about 60 percent of cases there’s sufficient data to approve a request without human intervention,” Dasgupta said. “These typically revolve around medication benefits and other common, straightforward requests. Our algorithm assigns a confidence score to deniable cases. Once a case reaches a certain threshold, the algorithm automatically sends it to a board-certified physician or nurse for their decision. The entire process is faster because the algorithm moves justifications through the system quickly, and with relevant information.”

Opportunities Expand with SAP.iO Foundries

Hindsait is among the cohort of seven startups that participated in the recently launched health-focused SAP.iO Foundry New York program, an accelerator for early-stage enterprise tech companies that are developing innovations for health systems, life sciences, payors, and employee well-being solutions. The program also provides mentoring from industry experts both within and outside SAP, tailored workshops, and access to SAP technologies. With an IT consulting background that included global SAP software implementations, Dasgupta was excited about the opportunity to work together.

“We’ve learned a lot from SAP leaders, including the company’s healthcare experts,” he shared. “As a startup, we’ve used SAP’s support to strengthen our business case, marketing strategy, and content management approaches.”

There is no question that AI will have a huge role in the future of healthcare. However, a recent Gartner survey found that despite having strong “digital business ambitions,” healthcare providers are lagging behind retail and finance services firms in digital transformation. Hindsait is a harbinger of what to expect as strategically applied AI helps cure what ails the healthcare industry.