How Payers used AI in 2020
Artificial Intelligence allowed for new strategies around value-based care, member agreements and medication adherence.
Artificial intelligence is often identified as the illusive technology of the future. Well, it turns out that payers started using AI in 2020 to advance 3 key strategic goals to benefit you, the consumer. First and foremost, payers are those who actually pay for the healthcare you get (if you’re insured) most commonly the health insurance companies. Government programs such as Medicare and Medicaid are also payers.
What are the three strategic goals?
Advancing value-based care: healthcare providers are paid based on the quality of care they provide, not the quantity of care in a fee-for-service model becoming a thing of the past. '
Personalized and streamlined member engagement: Members are consumers of the healthcare system, the insured and often the patients. Streamlining their agreements means improving efficiency of the healthcare system and how we navigate getting our healthcare, from finding a doctor to getting our test results.
Medication Adherence: If anyone has older parents or has been a caretaker, we all know the struggle of how to manage medications.
How did AI improve these three things? Well, believe it or not one of the silver linings of Covid-19 was that we had to look to technological and distance solutions to our healthcare system woes. This forced many payers to find innovative ways to progress and better serve you, their customers.
Advancements in value-based care came forth through technological improvements in data tracking. We know that our healthcare data is often scattered between records, doctors, specialists, online systems, etc. We also know that for anything to change in major industries you need data to support the change. Well, in 2020 there was more time to analyze data and put together a care model that looked at the whole patient. Payments as a fee-for service model dropped because elective procedures and routine care were suspended by the pandemic. This resulted in people seeking essential care and showed insurance companies that quality means more to people than quantity. Health payers are now inventing data integration systems that put together a whole picture of each patients’ health, allowing patients to navigate the system with clarity and providers are incentivized to provide the best care possible.
Just like scattered patient data, we all know how frustrating it can be to jump from doctors to specialists to radiologists, to you name it… and how we all get lost along the way with how to make sure we are doing it all correctly and not racking up a huge bill. Well, payers are now recognizing that this is a business opportunity and that supporting consumers means guiding them through the system. New apps allow patients or clients of certain health insurance companies to essentially have their hands held through finding the right physician, specialist, etc. Imagine being matched to a doctor who you could personally identify with?! Imagine scheduling an appointment through an app and not spending hours on call waiting and trying to catch voicemails in time. Well, this is the future of healthcare my friends.
Medication adherence isn’t as easy as it sounds. There are many barriers to entry or adherence such as a lack of information from doctors on why and how to take medications, what they need to do to access a refill, how to answer insurance questions to get your prescriptions, etc. Imagine if your prescription wasn’t in English and you spoke Spanish? Well some insurance companies developed a voice-activated assistant through Alexa to help people reorder their prescriptions. You can receive updates, reminders, and refill instructions from the technology you already use.
There’s a brighter future to look forward to and technology is going to help us get there, along with patient-centered care models that give you more of the good stuff and less of the complicated things.