As AI integrates into our day-to-day experiences, it makes sense that it comes to life in how we manage and engage with our health care ecosystem. A 2023 study found that payers are interested in AI-enabled solutions aligned to their strategic areas of focus, such as cost containment, member engagement, and payment integrity, and are likely to invest in solutions that utilize AI and natural language processing (NLP) capabilities, indicating a growing recognition of the potential for AI to drive business value in the health insurance industry.1 Smart health insurer payers establish guidance around technology use for the safety of their customers.
How health insurers should handle AI
By establishing clear guidelines and principles for AI development and deployment, health insurers can harness the potential of AI while minimizing its risks. Florida Blue, for instance, has implemented a multifaceted approach with strong ethical guardrails around AI. To ensure responsible AI development, it's essential to consider:
- Ensuring transparency
- Fairness for diverse audiences
- Protection for customer privacy
- Keeping a human in the loop
- Removing bias from data and algorithms
This helps ensure government regulations are met and a business’ data is treated with care and consideration. With these guardrails in place, group business customers can work with their broker to focus their strategy, enhance their competitive edge, and manage their costs.
“This tech offers a lot of opportunity, and our priorities of security, accuracy, and privacy are at the forefront of every utilization,” noted Svetlana Bender, Vice President, AI and Behavioral Science for Florida Blue. “We have our subject matter experts reviewing each use case and making sure our members’ privacy and health is first and foremost. We have a state-of-the-art framework that will allow us to implement high-quality and secure AI solutions.”
Knowing health care benefits are not a one-size-fits-all solution, the responsible use of AI can help drive considerable benefits for businesses of all sizes, including:
Personalized benefits administration
AI is enabling health insurance companies to offer personalized benefits administration, tailored to the unique needs of each group customer. Personalized benefits administration can lead to an increase in employee engagement and reduction in benefits costs. Collaborating with your health insurer can help create a custom roadmap that can bend the cost curve, sustainably reducing the upward trajectory of your costs over time.
Data-driven insights and analytics that inform action
At the heart of AI capabilities in health care is its ability to analyze claims data, employee demographics, and benefits usage to provide a fuller picture of group business accounts. AI-powered systems can identify trends, patterns, and areas for improvement that distill actionable insights from complex data sets. This enables business decision makers like you to make informed, data-driven decisions about your benefit strategy.
Cultivating benefits employees want and need
As AI is leveraged to optimize operations, it is also uncovering new opportunities to unlock the full potential of a workforce through enhanced employee engagement and wellness programs.
By analyzing employee data and health metrics, AI-powered systems are providing personalized wellness recommendations and identifying targeted incentives to drive employee healthy behaviors. Employers can use this data to foster a culture of well-being and care for an employee’s whole person health and mental and physical well-being. This leads to improved employee resilience and increased job satisfaction.
According to a Gallup study, engaged employees make it a point to show up to work and do more work — highly engaged business units realize a 41% reduction in absenteeism and a 17% increase in productivity.2 Hence, engaged employees equals improved job satisfaction, reduced absenteeism, and increased business performance.
Streamlining enrollment and onboarding
Thanks to the integration of AI, automating manual tasks and leveraging machine learning algorithms has helped health insurers reduce errors, improve data accuracy, and strengthen customer experience. AI-powered enrollment and onboarding can lead to a reduction in administrative costs, freeing up resources for group businesses.
The technology can also streamline health insurer processes like prior authorizations or free up customer service teams to focus more on complex cases and enable faster customer care for a harmonized experience for those who need it most. According to the 2023 EY-Parthenon and KLAS Research Payer Tech Study, 45% of (health) payers expect risk adjustment, condition management, and payment integrity solutions to be 'highly significant' areas of investment, highlighting the potential for AI to drive cost optimization, improve member engagement, and enhance payment integrity in the health insurance industry.1
Embracing the future
Ultimately, there’s not much AI isn’t significantly impacting, and it will only continue to grow. The future of group health insurance is being shaped by it, and forward-thinking businesses are poised to reap the rewards of this transformative technology.
Take the first step toward a more informed and effective benefits approach — consult with your broker today to learn more about how AI is shaping the future of group health insurance.
References:
1EY-Parthenon and KLAS Research. (2023). Health Care Payer Tech Survey 2023. Retrieved from https://www.ey.com/en_us/health/health-care-payer-tech-survey-2023
2Gallup. “State of the American Workplace Report.”2020. https://www.gallup.com/workplace/285818/state-american-workplace-report.aspx
