Analytics and AI can improve healthcare benefits decisions

By | 3 minute read | October 25, 2018

health and analaytic tools

Most of us are aware that advanced analytics and AI can help doctors diagnose disease and treat patients better. An area of decision support that’s been neglected, however, is healthcare benefits. This is unfortunate because benefits decisions can have serious financial and wellness consequences for every employer and its employees.

Indeed, a typical family of four spends an average of $22,030 on healthcare annually, $3,600 of that in out-of-pocket expenses. Healthcare plans are complex, making it a frustrating experience to understand and navigate plan choices. Almost 90 percent of healthcare consumers want a plan tailored to their unique situations and risks, yet most spend no more than 15 minutes evaluating plans.

On the employer side, benefits administrators face a bewildering array of options, with little to guide them in choosing plans in sync with unique employee populations. Most advisors use out-of-date actuarial models that can’t predict future medical costs.

That’s why our company, DZee Healthcare Financial Solutions, has developed forward-looking data analytics and decision-support solutions to optimize healthcare financial and plan-selection decisions. DZee Solutions uses IBM Watson services and machine learning delivered from the IBM Cloud in its healthcare financial software to help organizations and individuals understand, plan, and reduce healthcare costs and risks by selecting the best plans and benefits.

Applying analytics to benefits decisions

We apply data analytics and machine learning to a vast healthcare data repository to recommend the optimal benefits packages. Recently ported to the IBM Cloud, our system assists benefits advisors in recommending plans and benefits that match the health profiles of an employer’s workforce. It also recommends the best three healthcare plans and benefits for individuals and families based on their health, benefit usage, and financial needs.

DZee Solutions also has tools for financial advisors and consumers that predict lifetime medical and long-term care expenses to improve savings and retirement planning. And wellness providers use our analytics to help companies assess the ROI of the wellness programs.

The secret sauce is our healthcare data combined with our analytical and AI technology. Our machine-learning analytics crunch millions of healthcare claims, clinical outcomes data, and demographic correlations to recommend the best health-and-benefits plan for each person. DZee creates a personalized profile for each individual based on their personal health histories (and those of their families). It then analyzes approximately 1,000 variables for each health plan, and tests each plan against an individual’s actual benefits-consumption data, simulating how their health conditions may progress in the future. We can then use this data to develop projections for individuals and employers, over time frames from a year to a lifetime.

Improving productivity and saving money

Because our solution streamlines plan comparison, it improves productivity for everyone involved in healthcare benefit selection, including employees, HR and benefit administrators, benefit advisors and brokers—virtually any company in the healthcare benefits ecosystem. We also partner with HR technology platforms and wellness companies. We can add significant and immediate value to the HR workflow by improving productivity and reducing costs. Since our technology is available by API, it’s easy to integrate into virtually any system.

Employers realize the same benefits: improving productivity and reducing costs. Healthcare-benefit costs are typically 15 percent to as much as 30 percent lower.

Individuals, too, gain when employers pass the savings along. And scientific predictions of health expenses and risks help employees pick the right plan and set an appropriate savings rate. Access to such insights is a welcome employee perk.

We expect our relationship with IBM to magnify our solution’s value. We recently integrated DZee’s analytics with Watson-powered machine learning and the IBM Cloud, which has expanded our capabilities and scalability. We’re also exploring the integration of Watson Analytics, Truven Health Analytics from IBM Watson Health, IBM security and solutions from the IBM partner ecosystem. We’re convinced that DZee and IBM can improve healthcare by making medical costs and benefits more transparent to everyone.

Human resource leaders can finally breathe a collective sigh of relief now that HR benefits are undergoing a transformation—just as the talent and performance departments have over the past decade.

Hear Monique Reece discuss healthcare benefits decision support: