Technical innovations are radically transforming care delivery, and none more so than artificial intelligence (AI).
But historically, and for too long, the application of cutting-edge innovations has been mostly the purview of concierge care and the higher end of the healthcare marketplace.
Part of the promise of AI is the innovative technology’s ability to democratize access to knowledge, and this fundamental element is increasingly being leveraged to address legacy gaps within the healthcare system, particularly those related to serving underserved populations.
“We started Pair Team by asking how we could take all the tooling and technology and infrastructure built for concierge primary care and bring it to the safety net, the population that we have a sense of duty to serve — folks that are struggling not just with clinical issues, but what we call whole person issues,” Neil Batlivala, co-founder and chief executive officer at Pair Team, told PYMNTS in a conversation for the Matchmakers Series.
“This population doesn’t have time to think about their clinical needs until it is too late for them, and then they end up in the hospital,” Batlivala said. “So, we went to safety net providers who treat low-income beneficiaries on Medicaid and gave them tooling to better support their patients. That was the initial gap in the market: Medicaid is just riddled with access challenges.”
Compounding the challenges within Medicaid is a shortage of healthcare providers, leading to delays in patient appointments during which existing conditions can be exacerbated or grow worse.
Batlivala said solving for this requires treating community organizations, including shelters, pantries and rehab facilities, as sites of care.
“We’ve shifted from being a provider enablement organization to a community enablement organization,” he said, noting that these safety net organizations “have the trust of the community” and by providing them access to healthcare funding they can be empowered to fill ongoing care gaps for in-need populations.
“These are organizations that have been informally a part of the healthcare system forever, but they haven’t been formally part of it,” Batlivala said.
By providing these organizations with care management tools, data integration capabilities and telemedicine support, they are increasingly able to deliver high-quality care and bridge the gap between clinical needs and social determinants of health.
“We are basically building the equivalent of an EMR for these community-based organizations for how they can do care management … [and] starting to do a big push toward things like connected devices, sending wireless blood pressure monitors, smart scales, glucometers into these community organizations to make it more and more convenient to get access,” Batlivala said.
AI plays a crucial role by facilitating access to healthcare expertise and enabling cost-effective solutions. Large language models (LLMs) and generative AI capabilities have made healthcare expertise more accessible, allowing for efficient care management and expanding access through real-time translation services for non-English speaking communities, further enhancing convenience and access to healthcare services.
The importance of data and AI in driving effective care delivery and addressing the needs of underserved populations has become increasingly evident, particularly as AI can be used to identify high-needs individuals, facilitate telemedicine visits, and track and support care plans.
“Technology drives convenience and access, and that drives engagement. That’s what allows people to better utilize the healthcare system,” Batlivala said. “We do very granular tracking and supporting to help folks get care … the challenge is that these community centers are a sink where folks get sent, they catch everything but no one is there to support them … the baseline is much lower in these underserved communities.”
He emphasized the importance of data in segmenting populations by degree of need and care delivery system.
Regulatory reform in Medicaid has been a crucial factor in unlocking opportunities, and as a result, Batlivala said, community health workers are becoming a new provider type and an increasingly standardized workforce in the care delivery system.
As for what Batlivala sees 2024 holding, “There are about one and a half million community organizations; if you get just 1 or 2% to start providing care delivery services you’re effectively doubling the capacity of our Medicaid system,” he said. “At the end of the day, we just believe community organizations should be a formally recognized entity in our care delivery system. You need to look at the whole person. Care can’t just be clinical.”
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