Operational AI, Part 2: The DSM of Operational AI
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A practical framework for operational AI solutions in health care — no diagnosis required
In Part 1, we introduced potential use cases for operational AI. Now it’s time to bring in how we can map this in our minds. The framework below is designed to help you understand the major categories of operational AI solutions that are currently available in the market. These categories are neither mutually exclusive (because, as you know, your operations are not either) nor 100% comprehensive (as AI grows by the day), but they are a helpful way to get organized.
Apart from reviewing these at a high level, the intention is to give you a practical way to think about where you are facing operational burden and what category of AI solution that may fall into.
Welcome to Part 2 of our four-part series on operational AI:
- The Biggest AI Opportunity Is in Your Back Office: How Operational AI Solutions Can Drive Performance
- The DSM of Operational AI: A Practical Way to Organize the Operational AI Landscape
- Beyond Asking AI About AI: How Behavioral Health Leaders Find AI Solutions (coming soon!)
- What the Demo Won’t Tell You: How to Evaluate Operational AI Vendors (coming soon!)
What Is Not Included in This Article
This article does not discuss AI solutions that primarily focus on automating clinical workflows, independently diagnosing a patient, recommending or determining treatment, replacing a licensed clinician, providing autonomous therapy, or making clinical decisions. Those applications belong in a more clinically focused discussion. They require a different level of evidence, governance, risk review, and regulatory scrutiny and will be covered in a later article.
Operational AI Solution Areas
Patient Access, Intake & Navigation
What These Solutions Do
Help organizations move people from initial inquiry or referral into the appropriate service more efficiently.
Potential Capability
- Referral intake and routing
- Digital intake
- Scheduling
- Eligibility and benefits verification
- Waitlist management
- Appointment matching
- Call-center support
Potential Value
- Shorter wait times
- Fewer dropped referrals
- Reduced front-desk burden
- Improved conversion from referral to appointment
Clinical Documentation & Records
What These Solutions Do
Support the creation, review, organization, and retrieval of clinical documentation while maintaining clinician oversight.
Potential Capability
- Ambient documentation
- Draft progress notes
- Treatment-plan support
- Chart summarization
- Record abstraction
- Document search
- Identification of missing documentation
- Information extraction from outside records
Potential Value
- Less documentation burden
- More complete records
- Reduced after-hours work
- Faster access to relevant clinical information
Revenue Cycle Management
What These Solutions Do
Improve the accuracy, speed, and efficiency of the processes required to obtain payment for services.
Potential Capability
- Accurate coding and billing support
- Claim scrubbing
- Documentation-to-code review
- Prior authorization preparation and tracking
- Denial prediction
- Denial management
- Eligibility verification
- Payment posting
- Payer-rule monitoring
Potential Value
- Fewer preventable denials
- Improved coding and revenue capture
- Faster reimbursement
- Improved cash flow
- Reduced manual work for billing teams
Quality, Compliance & Accreditation
What These Solutions Do
Help organizations monitor whether services, records, and processes meet internal standards, payer requirements, regulations, and accreditation expectations.
Potential Capability
- Automated chart review
- Documentation audits
- Quality-assurance monitoring
- Policy and procedure review
- Regulatory monitoring
- Audit preparation
- Accreditation readiness
- Corrective-action tracking
- Compliance risk identification
Potential Value
- Broader and more consistent oversight vs sample sizes
- Earlier identification of risk
- Trend analysis of risks
- Reduced manual review
- Stronger audit readiness
Workforce Management & Development
What These Solutions Do
Support the recruitment, onboarding, deployment, development, and retention of the behavioral health workforce.
Potential Capability
- Candidate screening support
- Credentialing workflows
- Onboarding
- Staff scheduling
- Training-content development
- Competency tracking
- Supervision support
- Workforce forecasting
- Employee knowledge assistants
Potential Value
- Faster hiring and onboarding
- Reduced credentialing delays
- More efficient staffing
- Improved training and workforce support
Performance, Analytics & Reporting
What These Solutions Do
Turn operational and program data into reports, insights, forecasts, and management information.
Potential Capability
- Operational dashboards
- CCBHC reporting
- Grant and funder reporting
- Quality-measure reporting
- Outcomes reporting
- Productivity analysis
- Forecasting
- Trend identification
- Natural-language queries of organizational data
Potential Value
- Less time spent assembling reports
- Stronger performance visibility
- Earlier identification of problems
- Better operational decision-making
Workflow Automation & Enterprise Operations
What These Solutions Do
Help staff create, summarize, find, and use organizational knowledge across clinical and administrative functions.
Potential Capability
- Meeting summaries
- Grant and proposal drafting
- Board materials
- Internal communications
- Presentation development
- Document summarization
- Enterprise search
- Document Q&A tools
- Internal knowledge assistants
Potential Value
- Reduced time spent writing and searching
- Faster access to institutional knowledge
- Greater consistency
- More leadership and staff capacity
Patient Engagement & Communications
What These Solutions Do
Support communication with current and prospective patients before, during, and after care.
Potential Capability
- Appointment reminders
- Outreach
- Reengagement campaigns
- Follow-up messaging
- Multilingual communication
- Care-navigation messages
- Patient education
- Routine service updates
- Communication personalization
Potential Value
- Fewer no-shows
- Stronger engagement
- Improved continuity of care
- More consistent outreach without adding staff workload
Workflow Automation & Enterprise Operations
What These Solutions Do
Coordinate tasks, information, and actions across systems and departments rather than supporting only one isolated function.
Potential Capability
- Cross-functional workflow automation
- Task routing
- Organizational search
- Automated handoffs
- Exception management
- Operational command centers
- Coordination across intake, documentation, billing and reporting
Potential Value
- Fewer manual handoffs
- Less duplication
- More connected workflows
- Faster resolution of operational issues organization-wide efficiency
What’s Next: Evaluating Operational AI Solutions
Operational AI is a broad and fast-changing landscape, but organizing solutions by the burdens they address can make it easier to see where they may fit. With these categories in mind, you can begin connecting your organization’s most persistent operational burdens to the types of AI solutions designed to address them. Part 3 will take the next step, looking at how to source and assess those solutions more specifically.
Guest Author
Principal Consultant, Impact Investing Initiative
National Council for Mental Wellbeing
