AI Will Revolutionize America’s Pharmacies
Everywhere we turn, we’re faced with yet another way AI promises to transform our experiences. From autocorrect and digital assistants to autonomous cars, AI is all around us. While some applications work better than others, there’s no doubt that change is coming. What does this mean for pharmacy? And the question in the back of many people’s minds: Will pharmacists become obsolete?
The answer is a resounding no. Despite advancements in AI, the demand for pharmacists is expected to remain high due to the aging population, healthcare provider shortages and the evolving role of pharmacy as the front door to healthcare. Moreover, there will always be a role for human interaction, and patient trust in their pharmacist can’t be replaced.
That said, AI can help smooth the pharmacist-patient interaction and help pharmacists focus time and energy on high-value healthcare services, the reason people chose to become pharmacists in the first place.
Let’s take a look at a typical interaction and then look at how AI is on the cusp of improving the experience—at each point—to improve the overall cycle by facilitating the following:
- Automating the collection of patient information for record-keeping and billing purposes before the visit
- Enhancing the patient-pharmacist dialogue during the appointment
- Reducing surprise out-of-pocket expenses and billing errors after the visit
- Streamlining ongoing revenue cycle management (RCM) for pharmacies
AI Saves Time
For patients, visiting the local pharmacy should be simple. Make an appointment. Upload a photo of the insurance card. Meet with the pharmacist.
If only it were so easy.
Instead, just completing the paperwork for a first-time patient visit can take an inordinate amount of time. The patient is typically asked to enter insurance information and history manually, on multiple forms, all attached to a clipboard. This can take up to 20 minutes for someone who may be managing multiple chronic conditions or has a complicated medical history. Then, these same forms are returned to the pharmacist, who can take additional time to enter the information into their system, work through patient eligibility determination, benefit coverage and obtaining out-of-pocket estimates that consider deductibles co-insurance and co-pays. That’s quality time no one can spare!
Enter AI.
In the near future, AI will enhance the front-end patient experience by automating data collection and communication, reducing paperwork and confusion. At the same time, AI will significantly lower pharmacy costs by reducing administrative burdens while improving efficiency.
In our complicated healthcare system, every insurance card is different, and each poses a unique conundrum for healthcare providers. The lack of standardization in insurance cards, with varying terminology and formats, creates an extra layer of complexity in healthcare encounters.
Leveraging insurance card processing and technologies like optical character recognition (OCR), natural language processing (NLP), and machine learning (ML), AI is expected to bring much-needed sanity to the inefficiencies and duplication in today’s system. By streamlining healthcare processes, eliminating repetitive paperwork, reducing inaccuracies in patient data and speeding additional administrative tasks, AI can help to speed the visit for both pharmacist and patient.
AI Enhances Patient-Pharmacist Interactions
During the visit, AI can alert a pharmacist to items needing review, thereby potentially reducing medication errors that might otherwise be overlooked, while providing data-driven insights. While its role in clinical decision-making is still evolving, AI can act as an additional safety net for pharmacists and their teams. Greatly reducing errors improves care and increases trust.
Building this foundation of trust helps enhance ongoing pharmacist-patient communication and care. This is particularly important for managing chronic conditions or scheduling additional visits.
In the longer term, AI is expected to improve patient outcomes by optimizing follow-up care and providing personalized assistance to patients and pharmacists.
AI Minimizes Surprises
Unfortunately, not all surprises are good ones. No one likes seeing an unexpected balance due on a bill for a service that was provided some time ago. It’s frustrating all around.
As medical claims become more complex, the harsh reality of a surprise charge or balance hits both patients and providers. Patients have grown accustomed to trusting that the price of their services is what the pharmacist said it would be. When this isn’t the case, it creates confusion and frustration. It widens the trust gap between patient and provider, impacting ongoing care. For the pharmacist, it also means additional delays and more administrative work.
ML that looks at specific source data for payment history and encounter information can calculate precise payment information. AI, using ML, can assist with patient responsibility estimations, making AI better able to address the challenge of surprise charges than other methods. This helps improve the accuracy of the price estimate to a patient and is the price they can most likely expect to pay, while reducing unpaid or underpaid claims.
AI Helps RCM Reduce Costs
For pharmacies, managing revenue cycle management (RCM) has taken on increasing importance, particularly as more patients seek care at their local pharmacy. The surge in visits and the shifts in the types of care patients seek at pharmacies have elevated their status as a preferred venue for care.
On an ongoing basis, reducing claim denials presents pharmacies with a major opportunity for enhancing reimbursement. RCM makes this possible by simplifying insurance claim processes, ensuring accuracy and supporting compliance. This all helps pharmacies better manage workflow and accelerate growth.
AI can significantly streamline pharmacy RCM, particularly in simplifying insurance claim processes by automating tasks, such as eligibility verification, prior authorization and payment posting. Overall, AI can improve accuracy and enhance efficiency as part of RCM through the following:
- Removing friction from the pharmacy patient billing experience
- Reducing the administrative burden and cost
- Accelerating collections and maximizing revenueThe Transformation Is Coming
By enhancing the experience for patients and pharmacists alike, AI will become the backbone of pharmacy operations, simplifying complex processes and improving cost efficiency, while enhancing—not diminishing—the essential human connection between pharmacists and patients.
AI will allow pharmacists to have the tools, processes and information they need when a patient walks in, facilitating the interactions before, during, and after the visit. The result is increased efficiency, greater patient satisfaction, and better health outcomes.
Done right, AI will be a seamless support. Neither patients nor pharmacists will even realize AI is in play. It will be integrated into their experiences. The transformation with AI-driven pharmacy solutions will set the new industry standard.
David Pope, PharmD, is chief pharmacy officer at XiFin; Jeff Carmichael is senior vice president of engineering at XiFin.
