Artificial Intelligence (AI) and machine-language learning get a bit of a bad reputation because most stories you hear about them are either very cautious or downright negative. But some health insurance companies today are using artificial intelligence and machine learning in ways not possible just five years ago to better pinpoint at-risk individuals, reduce costs and optimize healthcare for workers with chronic conditions.
Optum, for instance, is now running a pilot program for insurers to take advantage of AI in processes done manually, according to Mark Morsch, vice president of Technology for Optum360. “The applicability and opportunity on the insurers side is fantastic,” said Morsch. “The biggest breakthroughs are in more sophisticated machine learning.”
In addition to medical record review, insurance companies are applying AI and machine learning algorithms to risk management. “Insurers must be able to assess risk correctly to set the right premium,” said Frank Jackson, executive vice president of Payer Markets for Prognos. “If they miss slightly on pricing and go too low, it can be costly,” he added. “But if priced too high, they might lose that employer contract next year.”
AI and machine learning move from a custom and reactive approach to more standardized and proactive management of patient care. “One of the biggest results is the high engagement rate we’ve been able to achieve,” said Dr. Trishan Panch, chief medical officer at Wellframe, who is using AI to optimize healthcare for chronic conditions.
“One surprising thing is that patients do not find it creepy to be in a remote relationship with a clinician,” Panch said. “The fact that it’s happening over a mobile device with some phone calls, the experience has held,” Panch continued. “The beauty of technology is, you can bring it to more people for a longer period of time.”
So we see that AI is already transforming different aspects of the health insurance/health care industries. Ruling your world is about knowing that so you can can always make the best decisions for your employees and your company. Call on our AI (Actually Intelligent) team of health care insurance and employee benefits experts to help you with any questions or concerns!
How health insurance companies use AI to make consumers healthier