Skip to main content

AI has limitless applications in healthcare, but it offers unique and specific potential in payer spaces.

But payers also face new and complex challenges that cause hesitation.

It’s important not to get caught up in the current excitement around AI but to first identify where AI could have the greatest impact on your daily operations. To successfully integrate AI into your existing operations, enhancing productivity and improving the member experience, it requires dedicated resources and a deep understanding of issues impacting your organization.

Payers should actively seek opportunities to build connections with both internal and external AI experts before making any substantial investments.

Hear more from industry leaders and their thoughts on incorporating AI, check out snippets from our Fireside Chat.

“Show us what [AI] can do. [Vendors need to] show us the savings we can get and then we will pay [them] based on that. That is the kind of vendor relationship I am looking for right now. I’m not looking to throw hundreds-of-thousands of dollars at someone and hoping that it works.”

-Shares Daverick Issac, Chief Financial Officer at Community First Health Plans during our Fireside Chat about AI

Health payers are taking steps to launch new AI initiatives, they’re just being cautious.

Download our latest whitepaper “Navigating the AI Revolution” for more insights from health plan leaders, industry researchers, and the technology behind healthcare AI. Discover how AI can optimize operations, improve health outcomes, and pave the way for a more efficient and patient-centric healthcare ecosystem.

Current Use Cases for AI: Whitepaper Sneak Peak

In an environment marked by high inflation and dynamic market needs, strategies to enhance margins are becoming even more crucial.

Bain & Company recommends a dual approach, focusing not only on cost reduction but also on heightened productivity through strategic technology adoption. AI is increasingly seen as the key to accelerating productivity at a lower cost.

Current AI use cases for healthcare operations:

Automated Healthcare Administration

AI streamlines administrative tasks in healthcare, such as enrollment processing, billing, and claims processing. This reduces the likelihood of errors and allows staff to focus on more complex tasks.

Predictive Analytics

AI’s predictive capabilities help anticipate members’ needs by analyzing historical data and trends. Payers can proactively allocate resources and tailor services, ensuring members receive the necessary care and services.

Member Engagement

AI enhances member engagement and information quality. It supports agents, brokers, and call-center staff by providing pertinent information. Some payers have AI-powered repositories of member-facing documents that generate pre-written responses based on specific member interactions, making enrollment and coverage maintenance easier.

Ongoing advancements and evolving use cases continue to shape AI’s potential, allowing payers to swiftly adapt to business demands and member requirements, futureproofing operations.

For more information about Softheon’s healthcare payer AI capabilities, download our whitepaper for more.