3 ways artificial intelligence can help payers achieve their goals

The possibilities of artificial intelligence (AI) are no longer just in the imaginations of science fiction writers. As technology advances, we’re seeing real applications of AI used in a number of fields to tailor products and services more closely to the needs of specific consumers.

For example, 1-800-Flowers offers a gift concierge via its mobile app that delivers product suggestions based on a series of qualifying questions such as the type of occasion and sentiment. The more a customer uses the app, AI enables the system to learn about an individual’s needs. The result over time is a more personalized shopping experience and faster transactions.

A steady diet of streaming entertainment services has already set a benchmark for what people expect from online interactions. It’s unlikely consumers even know AI is behind the customized service. As more companies invest in AI-enabled technology, the bar rises for what customers demand from all service providers for convenience, accuracy and quick results.

Healthcare payers have the opportunity to get out front of customer desires now, by applying AI toward three common goals:

 1.  Improving health outcomes – Care managers access members’ information in advance of interactions with them. A care management system that incorporates AI can help add to the effectiveness of those interactions, and of treatment plans. For example, based on the free text in the member’s care notes, the system can find and highlight useful journal entries making it easier for care managers to connect the dots. An AI-enabled system can also recommend pertinent information for the care manager to collect during an assessment.

2.  Enhancing the consumer experience – Navigating the ins and outs of benefits can be confusing for employees and health plan members. The addition of virtual agents powered by AI technology can help improve the experience by providing fast answers to specific questions via convenient self-service channels, or transfer to a live agent for assistance when needed.

3.  Lowering the cost of care – Using AI, an organization can analyze integrated claims and clinical data to break down complex queries and quickly determine a member’s eligible services. AI can also be used to alert a member if it identifies a care gap for a chronic condition or if a preventative health measure is overdue. These actions can help increase efficiency and reduce the overall cost of care.

 AI is the next logical step to get more meaning out of the vast amounts of data available to payers, by making connections that can be used to improve health outcomes, customer interactions and lower overall costs.

In the white paper “Engaging healthcare consumers with artificial intelligence solutions,”  we talk in more depth about ways in which payers can leverage cognitive technologies for efficient, personalized service.