Andrea Rios
Vice President of Employee Health and Benefits - West
Health care, like many other industries, is adopting artificial intelligence (AI) for various applications. A recent study revealed 86% of health care providers, life sciences companies and tech vendors utilize AI in some capacity. Improving diagnostic processes and data analysis to upping administrative efficiencies are just some of the AI integrations used in health care today. But AI integration in health care doesn’t stop there — it’s also changing the way businesses approach health care insurance and benefits.
As with many other facets of health care, the health care insurance market is turning to AI to help problem solve and deploy new strategies to save time and improve efficiencies. While AI is pivoting relatively slower in this field compared with other aspects of health care, there are evident ways its use impacts and benefits workplace health care insurance practices, saving valuable time and money.
Top issues impacting AI & health care integration
There are several ways AI integration impacts health care insurance for employers and employees in terms of accessibility, delivery and use. Some of the most common include data and claims analysis, predictive modeling, fraud detection and enhancing member services. Here’s how:
- Claims processing and analysis: AI significantly saves time for businesses by automating the claims process in data extraction, validation and decision-making. It can also save employers money by identifying and correcting claims errors. AI is also opening new doors for policyholders by analyzing past claims to find the most cost-effective treatments and procedures.
- Predictive modeling: It would take an insurer an exorbitant amount of time to manually gather and analyze a demographic of patient claims, outcomes, medical history and disease prevalence to maximize health care benefits to lower costs. AI, however, can analyze massive data sets quickly and efficiently. This could allow it to help identify critical trends, such as for a specific geographical area. For example, if AI identifies a growing population of diabetes in a particular city, a company can use that data to provide or increase employee education about that disease. In essence, AI predictive modeling saves companies valuable time and money by allowing employers to implement preventative health measures for employees, which in-turn helps reduce health care premiums for policyholders.
- Fraud detection: According to the U.S. Department of Justice, health care expenditures in the U.S. exceed $1 trillion annually, an estimated $100 billion of which is potentially lost in fraud, waste and abuse. AI’s functionality to identify fraudulent claims — quickly and in real-time — as well as integrations that can prevent fraud from happening in the first place, protect insurance companies from costly financial losses. When insurers are safeguarded from fraudulent claims and spared the resources needed to rectify them, employers save time and money. Employees ultimately benefit by having lower health insurance premiums.
- Enhancing member services: Responsiveness to member needs has already proved AI to be an invaluable asset in health care insurance. Whereas humans are limited in their availability to serve members around the clock, (ex. No representative is on the clock to answer questions about a claim at 11:30 p.m.), AI is available 24/7. Beyond claim queries, AI is already helping in some workplaces through certain insurance plans to provide virtual health care options, employing front-end triage services and general patient intake.
Addressing security concerns
Most discussions of AI in health care integration naturally include concerns about data security and privacy. For all of AI’s benefits in improving efficiencies and lowering health care insurance costs, what about the potential price paid resulting from security and privacy breaches?
The reality is that protected health information (PHI), which includes all created, collected or transmitted identifiable health information maintained or covered by a health care entity, is always at risk. In 2023, more than 124 million records were compromised in health care hacking incidents, which is 93.5% of the year’s total number of breached records.
With that said, there are measures in place to help mitigate data security and privacy breaches where AI is concerned, which include:
- Encryption
- Strict authorization controls such as passwords, biometrics or multi-factor authentication
- Anonymization and de-identification of information from PHI (these processes remove or alter personal information from pertinent health assets)
- Data breach detection and response
- Routine audits of protection implementations
- Compliance with relevant regulations such as the Health Insurance Portability and Accountability Act (HIPAA)
The future of AI integration with health care insurance
The potential for AI to perform even more functions in the health care insurance space is just scratching the surface. Some of the emerging AI integrations taking shape include:
- Open enrollment and education: AI has great potential to help clarify, simplify and enhance accessibility of employee health insurance open enrollment and education. For example, AI chatbots are already being deployed to help members ask specific questions and compare policies, schedule reminders and appointments during open enrollment and provide cost estimations. AI can also be used to customize educational content specific to policyholders’ health priorities and interests (including videos, articles and more).
- Empowering employees: According to a recent study, prescription medication costs are growing close to two times more than general health benefits, at a steady rate of 6.8%. AI can help keep inflated prescription costs down by providing members with cost-effective options (such as generic drugs and where to fill them).
Important takeaways
One of the most important conclusions of how AI integration impacts the health care insurance industry is that the benefits outweigh the drawbacks. To help alleviate resistance to AI implementation, knowledge is power. Providing proper training to human resources staff, educating employees and staying abreast of the latest evolutions in AI health care benefits, options and uses can help relieve most concerns among employers and members.
How can AI interact with your health care plans? MMA can help
MMA has a growing interest and expertise in AI and health care integration. Our expert-led team specializes in providing technology solutions to help improve the efficiencies and overall operations of businesses from around the globe.
Discover our comprehensive range of business insurance, employee health and benefits, retirement and private client insurance solutions tailored to both businesses and individuals. Connect with an MMA representative today to explore how we can serve your unique needs.
