AI can End the Struggles for Health Insurance

AI can End the Struggles for Health Insurance

Healthcare Tech Outlook | Friday, August 02, 2019

Using AI-based and predictive analytics solutions, insurers can save massive amounts, streamlining their administrative processes.

FREMONT, CA: Health insurance companies are struggling to deal with the industry's skyrocketing costs and a mountain of paperwork. On average, Americans spend $448 billion on healthcare. In 2017, the price tag had inflated to $3.5 trillion drifting to and from insurers, Medicare and Medicaid through patient premiums and claims payouts to drug companies and healthcare providers. Due to the increasing complexity, the experts are eyeing the introduction of artificial intelligence (AI).

According to a recent Accenture study, using AI-based solutions, insurers can save up to $7 billion over 18 months and streamline their administrative processes. The research also indicates that automating routine business tasks alone could save $15 million per 100 permanent employees. Apart from reducing wasteful spending, AI can also help insurers improve consumer’s overall health. Around 72 percent of health insurance executives say that investing in AI will be one of their top three strategic priorities in the following year. While several players are eyeing to leverage AI, its impact is already rippling across the industry. Here are the ways in which AI technology is transforming the industry today:

Customer Engagement through AI Bots

AI-chatbots are already making a difference by engaging the customers by assisting them with customer support. By 2030, AI-driven customer engagement will be the norm. It will be the primary touchpoint for the insurance customers while human engagement is expected to reduce by 70 to 90 percent. According to the Accenture report, 68 percent of insurers are already using chatbots across various segments of their business processes. The consulting form further adds that health insurance companies can save more than $2 billion annually through AI incorporations to manage customer interactions.

Smarter Claims Management

According to a Mckinsey study, among every ten healthcare claims received, insurers mark as many as eight as unusual based on the company's guidelines. Up to 80 percent of all claims have to be reviewed by adjusters, which require a significant amount of money, time, and human effort.

However, Ai is transforming claims processing within the insurance industry using algorithms that spot an anomaly in seconds, thereby reducing time, money, effort.

Predicting ER Visits

Major insurers are searching for ways to leverage AI solutions to eliminate adverse health outcomes before they occur. They are also investing in tech startups to tap their innovative analytics. For instance, some healthcare AI startups are utilizing predictive modeling to recommend healthcare intervention before medical crises. Early interventions mainly help patients who are suffering from chronic illness. Currently, around 75 percent of the total healthcare costs arise out of chronic conditions such as diabetes and non-terminal cancer. According to indicators, Predictive analyses can indicate an impending health condition. For instance, when a patient visits a specialist or searches for symptoms online, AI identifies patterns that indicate whether it is the right moment in time for a person to seek intervention. With early interventions, insurers can engage them in preemptive care. 

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