We need to reset the payer-provider relationship — here’s how AI can help

June 15, 2021

For decades, payers and providers have operated almost as adversaries, each frustrated with perceived — or real — problems that the other causes. But the problem is not the actual relationship, it is the lack of sophisticated technology connecting these two parties to make healthcare more efficient. The payer-provider relationship, while often tense and burdened with mutual frustration, is at the same time central to the care patients receive. Unfortunately, inefficiencies on both sides of the aisle too often lead to delays in care, increased costs and patient frustration. Luckily, there is a way forward that leads to mutually desirable results: artificial intelligence and intelligent automation. 

AI is the solution to the payer-provider data gap

Today, payers and providers have completely separate technologies and systems. They do not talk to one another, and information is not shared easily between the two. It’s why, in 2021, we’re still relying on fax machines for prior authorizations. Artificial intelligence is the solution to bridging this gap, connecting payers and providers in a completely new way.  Artificial intelligence technologies can work on top of existing softwares and systems, enabling data sharing and connection without changing the solutions payers and providers have already invested in. They also have the potential to create a network of information that can unlock the insights hidden in our healthcare data, improving provider care and payer utilization management. 

Olive is connecting payers and providers in its AI network

Olive is a healthcare-only artificial intelligence company, committed to tackling healthcare’s $1 trillion of administrative waste. To do that, we are creating the Internet of Healthcare, connecting payers and providers to unleash the power of the data being generated every day. In the past few years, we’ve been focused on providers, growing our presence in health systems across the country to help their organizations reduce costs and improve operational efficiencies in the revenue cycle, supply chain, pharmacy and more. But one of the things we found is that providers are only half of the equation. To truly transform healthcare administration, we need technology that spans the payer-provider relationship, connecting these two groups that together are the crux of the patient experience. That’s why we’re expanding our AI solutions to serve payers, so we can connect these previously unconnected and even adversarial parties, solving mutual problems and helping payers find new operational efficiencies and patient data insights that improve utilization management. 

How payers benefit from Olive’s AI

Payers will benefit from Olive’s artificial intelligence capabilities in multiple ways.
  • Improved operational efficiencies: Just like in every other industry across the globe, payers can cut costs, reduce errors and save time by implementing AI and intelligent automation across their processes, such as in billing and claims management or member engagement. According to Accenture, U.S. health insurers can unlock up to $7 billion in operating income using AI — which for an individual health plan, equates to $1.5 million for every 100 FTEs.   
  • Discover data-driven insights by joining the Internet of Healthcare: Finally, EMRs are rolled out into almost every healthcare organization, meaning that each facility has an electronic record of data. But without an overarching technology, these systems of records remain siloed. Olive is a network of intelligence that captures and ingests the data from each facility to improve her knowledge and performance. Now, Olive can bring that network of intelligence to payers and create the Internet of Healthcare. Payers can have unparalleled access to robust clinical information and patient medical records to improve utilization management.
  • Become providers’ plan of choice: By implementing cutting edge technology, payers can accelerate and improve their processes, resulting in fewer bottlenecks or errors that leak over to providers. Providers will see you as a plan that is easy to work with, fast and accurate. They will trust you and your coverage, making you their plan of choice to work with. For providers that also use Olive, processes will be even more frictionless, with less paperwork and more AI support that enhances the patient experience.
  • Improve healthcare as an industry and for patients: Healthcare’s administrative processes are holding back the system from being its best. Instead of using our human intellect and resources toward process improvement, new ideas, or best-in-class patient care and experiences, human workers have become data routers and paper pushers. With a unified artificial intelligence network connecting payers and providers, healthcare can instead find unprecedented efficiencies. These efficiencies will benefit our payers and providers as a whole, healthcare employees at every level, and finally, and most importantly, the patients themselves, by providing faster access to appropriate care and fewer financial questions.   

From adversaries to partners

AI is changing the playing field for payers and providers. And now, instead of looking at standalone solutions to improve piecemeal processes, payers and providers can deploy AI throughout their organizations. They can gain the operational efficiencies of intelligent automation and the power of data and interoperability by joining the Internet of Healthcare.  Delight your members and network providers — learn more about how Olive is creating the Internet of Healthcare for payers.