In today’s age of digitalization, keeping up with consumers’ health insurance demands while constantly outdoing competition is a complex endeavor.
With global health care spending expected to rise at a CAGR of 5% in 2019-23, helping consumers live a healthier life and offer simple and affordable health insurance options is tough. It requires healthcare payers to continually fine-tune their strategies and embrace the wave of technological innovations.
Advancements in AI and machine learning are a great way to more efficiently identify at-risk individuals, streamline the insurance process, maximize revenue, and reduce costs.
The challenges that plague health insurance
As the health insurance customer gets more and more empowered, healthcare payers need to modernize their approach to communicate and meet their customers’ expectations. Increasing premiums, the unprecedented mushrooming of private insurance companies, and the advances in employer-based coverage are making the health insurance industry face more than its share of major challenges:
- Complex settlement processes need a lot of human effort and are extremely cost- and time-intensive.
- The presence of multiple third parties, and intermediaries makes collaboration difficult.
- Multiple platforms being used within organizations with a large percentage of work done manually increase the chances of billing and settlement errors.
- Complicated pricing models that lack transparency and impact customer loyalty in the long run.
- Archaic card processing technology and payment gateways and lack of support for new-age payment options such as virtual currency, e-wallets, mobile payment, etc.
- Legacy processing systems offer poor scalability as transaction volumes increase.
The realm of AI
For an industry that is plagued by an array of challenges that eventually impact customer experience, the promises that AI holds are many.
Using AI, healthcare payers can streamline a variety of insurance-related tasks, including medical history evaluation, insurance authorization, claims review as well as post-payment auditing.
Here are some ways in which AI can help healthcare payers maximize revenue:
- Eliminate manual tasks: The insurance claims process often relies on companies reading through consumers’ health records, determining if they qualify for benefits, and understanding what policies they are authorized for. However, with AI, healthcare payers can automate all these tasks and streamline the insurance process. Since AI algorithms can automatically assess claims – without the need for human intervention – healthcare payers can make smarter and unbiased underwriting decisions. Such an assessment can not only reduce fraud but also create positive customer experiences.
- Manage and optimize risk: Managing risk has always been a Herculean task for healthcare payers. Despite all measures, companies end up losing a lot of revenue because of the lack of modern technology adoption. According to the Healthcare Fraud and Abuse Annual Review, in 2019, $2.6 billion in fraud recoveries were collected from healthcare companies. AI can help healthcare payers efficiently manage and predict risk. Through the use of modern AI models, companies can assess the risk profile of insured customers and make the right premium decisions. AI can also help them in determining which customers need the most care and which will drive the highest cost, so that insurers can expend their resources towards these high-value customers.
- Reduce costs: With the cost of covering health insurance for workers expected to hit an average of $15,375 in 2020, healthcare payers are under immense pressure to reduce costs. To offer the best insurance cover while minimizing costs, AI can help healthcare payers make accurate, data-driven decisions. Payers can move from using a reactive approach to claims processing to one that’s more standardized and proactive in nature. Since all claim decisions will be taken based on hard-evidence, payers can drastically cut down on costs incurred in false claims. Such an approach can not only help payers maximize revenue but also support efforts to improve the overall patient experience.
- Drive engaging customer experiences: As insurance customers become more and more informed, they want their insurance-related queries to be solved quickly and expect the insurance claims process to be smooth and stress-free. AI technology can enable patients to engage with payers using their mobile devices and get answers to their questions through text messages, email, and chat. From sifting through different health plans to inquiring about billing and claims, understanding benefit and policy changes, and seamlessly managing their accounts – using AI, healthcare payers can offer a multitude of self-service and omnichannel solutions to deliver timely, personalized information.
Deliver exceptional results
As the health insurance industry faces several reforms, including new payment models and cost pressures, healthcare payers are facing disruptive change in recent years.
For those looking to respond to falling margins and move towards value-based models, embracing new-age technologies like AI is the only way to streamline claims processing, efficiently manage compliance, and improve customer experiences. With AI, healthcare payers can not only transform their business to deliver exceptional results for customers but also be armed to face the future with confidence.
