Harnessing Artificial Intelligence for your Health Plan

Personalizing the healthcare experience for members is top of mind in 2018, however lingering inefficiencies and communication gaps continue to hamper system-wide progress toward achieving the overarching goal—higher quality health care and improved population health outcomes at a lower cost.

Although the healthcare reform movement has brought about many positive changes, one innovation that is going to take over in 2018 and the coming years is the use of Artificial Intelligence (AI) to eliminate said inefficiencies and errors while providing a customized member experience. Given the breadth of influence AI is going to have (or in some cases, already has) in healthcare, below are some of the major areas where you can start using existing technology to automate your manual processes, cut costs, and improve satisfaction.

Handling chronic conditions more effectively

The multiple interrelated barriers to improvement are most evident in care for the population of patients with multiple chronic conditions. During transitions of care, the lack of integration among various silos and inadequate communication among providers cause delays in delivering appropriate health care services to these vulnerable patients, diminishing positive health outcomes and driving costs ever higher. Wi-Fi and cellular-enabled wearables already have a major foothold in ongoing improved health, but we’re also starting to see more traction with AI as it relates to chronic conditions. AI and predictive analytics can combine to give us ways to predict heart arrhythmias and blood counts that can help doctors help patients to engage and participate in managing their illnesses with built-in insights that don’t have time-delays or potential for human error.

Processing the unstructured data floating around is one key to moving beyond our current state of condition management. To take a proactive approach we need predictive analytics. Using both AI and predictive algorithms, we can combine the data to improve clinical decisions. It’s a balance of giving the right information at the right time to the right person. Current technology allows plans to create a customized experience for every member — something that, for various reasons, our industry has been slow to adopt.

Improving the shopping experience with virtual assistant

In a 2016 survey by research firm AYTM, 89 percent of consumers worldwide said they want to use a virtual agent to get information instead of searching through a company’s website or mobile app. That preference is good news for plans exploring more efficient and effective ways to engage shoppers and switchers. With first-contact resolution in the high seventy percentile, it frees up the number of live-agents necessary while reserving existing agents to provide high quality service to members who have more complex questions or situations. Over time, the system intelligence will improve based on the data the system collects. The type and number of inquiries will reveal obvious information barriers, and frequently asked questions will dictate content and give actionable insights based on the questions. Implementing the system is the hardest part; it only gets better over time.

Boosting Star Ratings with proactive engagement

Enrollment increases are most strongly correlated with Medicare Star performance ratings. This leaves major opportunity for plans to use automated text messages, emails and phone calls to boost compliance in a cost-effective manner. Communications can range from medication adherence to mammogram reminders to postoperative follow-ups and appointment scheduling. It’s crucial to choose a platform that can create, issue, monitor and measure communication across multiple channels instead of separate or disjointed platforms for email, text and calls. An advanced platform should be able to not only act on explicit member preferences, but glean implicit preferences from member actions, such as their preferred communication method and time of day to reach them.

With consideration to all the uncertainty and change to the health plan industry, the upside is that artificial intelligence has, and will continue to be a way to maximize savings, outcomes and satisfaction. There are numerous ways that AI will continue to improve on the health insurance experience for consumers in 2018 and beyond.