Leveraging AI to Improve Access to Specialty Care

This is the latest edition of a Manatt Health series on AI for health systems, stemming from a recent Manatt Health white paper. Click, here to read the white paper and here to read our first issue.

Accessing specialty care such as cardiology, psychiatry or obstetrics and gynecology often involves navigating a complex web of challenges: identifying the right providers, optimizing visit scheduling to minimize long wait times, confirming insurance eligibility, and analyzing available health data to make the best choice for the patient. These barriers challenge both patients and their referring providers, leading to costly delays in diagnosis and treatment.

Artificial intelligence (AI) offers transformative solutions to these barriers. By streamlining provider identification, AI tools help patients connect with the most appropriate specialists. Scheduling systems powered by AI reduce wait times by optimizing provider availability and managing demand more efficiently. Navigating the insurance and eligibility landscape becomes less cumbersome with AI’s ability to simplify the prior authorization process and confirm eligibility. AI also empowers patients by improving accessibility of personal health data and leveraging that data to generate actionable insights. These capabilities enable individuals to make informed care decisions, actively engage in their health care, and can reduce the complexity of accessing specialty services.

Below, we explore AI’s impact on each of these specialty care access barriers in greater detail.

• AI improves care matching by identifying appropriate care options and streamlining specialist referrals. Complex cases often require navigating a maze of primary and specialty providers, which can delay care. By analyzing electronic health records and patient data, AI determines when primary care providers can address needs and when specialist intervention is required, based on a patient’s medical history, diagnosis and treatment needs. It automates referrals, simplifies administrative tasks, and ensures seamless information sharing between providers. This reduces the burden on subspecialists, accelerates access to appropriate care, and enhances the patient experience.
• AI optimizes scheduling and reduces wait times for specialty care. The U.S. faces a growing shortage of specialty physicians, as the Association of American Medical Colleges has reported, with an even greater scarcity projected as the population grows and ages. The National Academies of Sciences, Engineering, and Medicine has also highlighted concerns about the availability of pediatric subspecialty care in a recent consensus study report. Today, patients in rural or underserved urban areas often experience wait times for specialist visits that can stretch into months rather than days and may also need to travel long distances to see a provider. AI can address these challenges by searching across multiple provider networks and locations to identify available appointments, minimizing wait times and travel burdens. For in-person and virtual care, AI can streamline scheduling processes, ensuring patients are matched with the earliest and most accessible care options. This is particularly impactful in pediatric specialty care, where timely intervention is critical for developing children and deferring essential care can have long-term health consequences.
• AI simplifies insurance and specialty care eligibility navigation. AI can streamline the process of understanding insurance coverage, helping patients interpret complex terms; identify in-network providers; and confirm the necessary financial, referral, and clinical conditions to access care. By reducing the complexities of narrow networks or high-deductible plans, AI can help patients find affordable care options and avoid unnecessary out-of-network expenses. This is particularly valuable as insurance plans and provider networks fluctuate annually, especially for families navigating pediatric care, improving both access and satisfaction.
• AI enables patients to make informed specialty care decisions by generating actionable insights from their personal health data. By analyzing this data, AI tailors insights on clinical diagnoses, lifestyle factors and daily living concerns. This is particularly beneficial for patients with complex conditions who need real-time, personalized information. AI also compiles and standardizes relevant data into accessible resources like FAQs and best practices, making it easier for patients to manage their care and make decisions. AI chatbots can also provide interactive support and guidance to patients. These chatbots can answer questions, interpret medical information from clinical visits, test results and care plans, and offer real-time insights. By improving the accessibility and sharing of information, AI ensures that patients remain well-informed and can actively manage their health when accessing specialty care services.

Overall, AI can improve access to specialty care by simplifying navigation and quickly connecting patients to the right providers. It optimizes scheduling, streamlines referrals, and offers personalized insights from health data, ultimately improving system efficiency and patient outcomes. With the assistance of AI, patients can navigate complex specialty care systems more easily, receive timely, affordable care, and make more informed decisions about their health.

Our next article on AI approaches for safety net hospitals will be released on 1/9. To read the full series, and stay up to date on Manatt’s AI insights, click here.