Healthcare Innovation with Generative AI

For both healthcare payers and providers, Generative AI is a game-changer. Gen AI takes massive amounts of disparate, unstructured data like clinical notes, diagnostic images, medical charts, and recordings and then combines them with large, structured data sets like insurance claims to handle operational processing and analysis much faster and more efficiently.

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Key Challenges

Financial Difficulties and Rising Costs
Gen AI helps you undertake staffing shortages, higher costs, and reductions in reimbursement rates, which cause financial difficulties for health systems and impact patient experience, health care equity, quality, and availability.
Reimbursement Models and Pricing
Gen AI helps you deal with a shift to value-based care, reimbursement rates, lack of price transparency, limited patient payment options, and balancing quality care with affordability.
Increased Demand for Personalized Care
With the increase in consumerism and medical information on the internet, Gen AI helps you collaborate with patients, who are empowered to make their own healthcare decisions and expect diagnoses and treatments customized to their individual needs.
Patient Experience
As your focus moves from treating illnesses to preventing them, with Gen AI, healthcare systems now offer digital and personalized care options like mobile apps, communications, and recommendations customized to your patient's specific medical history and health requirements.
Claims Processing and Payment Accuracy
Gen AI helps with the timely processing of healthcare claims, which is a challenging and laborious process with potential for errors. With Gen AI, through automation, it is easier to correct application claims processing rules within regulatory guidelines and execute contracted agreements
Benefits Models and Pricing
With value-based care and different types of provider engagement, Gen AI helps you positively engage additional complexities in the financial model and challenges in predicting patterns of healthcare delivery that creates a lack of transparency in shifting to preventive care.
Provider Network Optimization
With Gen AI, you build and maintain complete, effective, and efficient provider networks, so you better control costs and ensure quality of care. You effectively analyze provider performance, which is important to optimize the network and manage contracts.
Customer Service and Support
Gen AI helps you maintain and improve member experiences with required timely and accurate support and personalized components that engage members individually. Get enhanced communication channels and better data, which are necessary to achieve the superior service your members expect.

Business Opportunities

Use Cases

Business Value

Case Simplicity

Virtual assistant for task automation

Gen AI uses bots to automate tasks like filling out forms, answering questions, simplifying complex processes, and enhancing user experience for HCPs, patients, care teams, and administrative staff.

High

Medium

Improve scheduling and billing

Gen AI creates efficiencies in scheduling and billing and streamlines prior authorization, claims tracking, and payment processing.

High

Medium

Payment operations efficiency

Gen AI manages and synthesizes care notes, builds comprehensive member profiles for payment authorization, and produces support materials for payment justification and reporting.

High

Medium

Broker collaboration engine

Gen AI enhances broker efficiency and collaboration with virtual assistants and real-time access to plans, coverage details, and pricing information. Use data-driven market research to find trends and gaps in coverage.

High

Low

Member attraction and retention

Gen AI finds ways to approach and appeal to new members, develop tailored benefit plans, retain existing members, and develop new business advantages for intermediaries approaching the market.

High

Nonstandard payment facilitation

Gen AI manages and synthesizes data and workflows to execute and track payment scenarios. Generate authorizations, documentation, and interpretation of member data to drive claim resolution actions.

High

Medium

Claims processing and payment accuracy

Gen AI interprets contract rules and CMS guidelines to verify payment accuracy and analyze provider practice patterns for opportunities to improve care and optimize cost.

High

Medium