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In a panel discussion hosted by Healthcare Dive last week, experts said payers that fully implement artificial intelligence can expect significant returns from their investments in administrative and medical cost savings.
Jessica Lam, a partner at consultancy McKinsey & Company, said widespread deployment of the latest technology would be “hugely transformative for the industry.” Lam estimates that insurers could reduce administrative expenses by at least 20% and healthcare costs by at least 10% if they implemented AI across their operations.
Lam said payers have numerous use cases for AI, from optimizing utilization management to improving claims reviews and streamlining enterprise functions.
When it comes to utilization management, Lam said insurers could leverage AI to speed up processes such as pre-approvals. Lamb said promoting faster treatment will help insurance companies save on health care costs in the long run by helping people get the care they need sooner.
Aashima Gupta, global director of healthcare at Google Cloud, agreed that AI can save valuable time during the November 19 event.
“It's all manual,” Mr. Gupta said of the historic claims review process. “We're now able to save time for clinicians and nurses. We all know these are scarce resources. These are also expensive resources.”
Major insurance companies have been leveraging AI in some form for years. However, adoption of generative AI (tools that use training data to create new content) is still on the rise, especially among nonprofits and small payers.
For example, 90% of health payers surveyed last December said they planned to increase their investments in AI this year, but only about 25% said they planned to consider generative AI. It was. The majority of respondents focused on using AI tools for predictive tasks such as underwriting and claims management.
Some lawmakers and providers on the sidelines have expressed concern about payers' plans to increase investment in AI.
Patients allege in the lawsuit that the companies are using the technology to deny them access to needed medical care. Lawmakers have similarly accused payers of using AI to deny care to Medicare Advantage plans in an effort to cut costs.
Lam and Gupta suggest that technology could protect against poor care decisions by keeping humans informed or giving approval to AI decisions. I did.
However, it is not clear whether human involvement will solve the high rejection rate. Congressional and media investigations have accused some insurance companies of high levels of deniability, even when claims decisions are scrutinized by humans.
Providers are particularly alarmed by rising denial rates. Providence Chief Financial Officer Gregg Hoffman said in an interview last month that the company's system was forced to implement its own AI to deal with an increase in payment declines, and that payers' use of AI has increased. He said this was the cause of the sudden increase.
Editor's note: Register here to watch a replay of the virtual event hosted by Healthcare Dive on November 19th.
