7 reasons payers should adopt AI and join the Internet of Healthcare

November 18, 2021

Artificial intelligence isn’t new — it’s been top of mind for years across a variety of industries, including healthcare. But most healthcare organizations, including payers, have barely scratched the surface of AI’s potential.

Payers need transformative AI, for their own success and to improve healthcare as a whole. It has the capability to provide immediate benefits today and long-term benefits in the future. But to move beyond the surface-level benefits of today, payers need to think bigger than isolated applications of AI. The transformative benefits of this technology can only be realized if payers join what we call the Internet of Healthcare. The Internet of Healthcare will move us beyond point AI solutions to an era of increased connectivity, accessibility and collaboration.

What is the Internet of Healthcare?

Plenty of companies claim to offer solutions that use artificial intelligence, but the Internet of Healthcare is so much more than that. To achieve transformation at scale — within an organization and throughout the entire healthcare industry — we need an actual network of intelligence. It’s a system that communicates as an ecosystem, sharing data and finding insights across previously disparate applications. It brings not just automation, but connectivity that will dramatically move the needle toward healthcare’s most important goal: better care at a lower cost.

The Internet of Healthcare report highlighted the need for widespread AI and increased connectivity for providers. But what does this mean for payers?

Here are seven reasons payers should join the Internet of Healthcare and start deploying AI at scale:

1. Reduce costs
The number one reason organizations look to automation is to reduce costs. With healthcare costs continuing to climb, the industry needs ways to reduce spending without reducing quality of care. And that is the beauty of artificial intelligence.

The Internet of Healthcare report found that provider administrative staff suspect an average of 21% of patient records have at least one error. With payers and providers as part of an Internet of Healthcare, these errors can be reduced dramatically. AI can automate payers’ manual, repetitive processes, simultaneously slashing administrative costs and human errors. And cybernetic solutions, or AI assistants that work alongside human employees to provide relevant information at their fingertips, improve the speed and accuracy of non-automatable work as well. These solutions provide a near-immediate ROI.

2. Expand capacity

When costs are reduced through proven AI solutions, both time and money can be redirected toward other, higher-value work. Artificial intelligence expands a payer’s capacity, unleashing the resources and focus to deploy new solutions, improve current processes and optimize their business model. It’s a self-fulfilling cycle that allows payers to make continuous improvements, generating more savings, improving the member and provider experience, and making them a leader in a highly competitive industry.

3. Increase employee satisfaction

While payers may not be experiencing the same worker shortage or massive employee burnout as providers, every employer benefits from increasing employee satisfaction. Manual, mundane tasks drain workers of their energy and enthusiasm, leading to lower productivity and higher turnover. The Internet of Healthcare turns human “data routers” into humans who do human work. This keeps employees more engaged and happier in the workplace.

4. Boost member experience

Complaints from members about their health insurance are all too common: too expensive, denied procedures, care delays, etc. What can payers do about this? How can they boost the member experience and improve member satisfaction? The answer is artificial intelligence — and in more ways than one.

In general, AI and the Internet of Healthcare will improve care and reduce medical costs over time, which will eventually impact the patient. But there are also several direct impacts on members, such as fewer billing errors, faster problem resolution and even fewer care delays. Artificial intelligence can automate the entire prior authorization process, enabling completely touchless prior authorization approvals and seamless clinical reviews.

5. Become providers’ plan of choice

Right now, the payer-provider relationship is full of friction. Outdated, unconnected systems and processes on both ends are leading to costly errors and a heavy administrative burden. Providers often view their health insurers as a bottleneck to providing patient care. With AI, payers can become a provider’s plan of choice by being the easiest and fastest to work with.

Today, AI can reduce or eliminate administrative barriers that impact care. For example, when the first U.S. payer delivered fully automated prior authorizations, including at the point-of-care, they reduced their average approval time, making them, on average, a week faster. The net promoter score of this project was a whopping 75 — on par with the scores of Starbucks and Amazon.

6. Improve member health outcomes

There is incredible potential with the Internet of Healthcare to uncover data that improves member health outcomes. 95% of healthcare executives are optimistic that AI will connect data systems to provide better insights and patient outcomes.

Processes that use artificial intelligence reduce errors, misdiagnoses and care delays that can negatively impact health. As more payers and providers join the Internet of Healthcare, the value of the amassed data will grow, allowing advanced AI to uncover insights that will improve individual and population health outcomes. One specific area of impact for payers is their provider network management. AI will be able to understand variations occurring at the point of care and how those variations impact outcomes. With this information, payers can provide tangible ways to tweak provider incentives and create optimal care paths.

7. Emerge as a leader in healthcare

The benefits of artificial intelligence have been proven time and time again in other industries. In healthcare, we’re still at the tip of the iceberg. The Internet of Healthcare will streamline processes, deliver insights and encourage partnerships with providers. Payers that fully embrace this technology will emerge as industry leaders and, most importantly, deliver best-in-class experiences to both members and providers.

Learn more about the Internet of Healthcare.