Health Insurance CIO’s Guide to Emerging Technology

Health insurance companies are rapidly transforming. Insurers now need to be member and data-centric to better compete in an increasingly competitive market. One of the ways insurers can outperform their peers is by leveraging emerging technology to streamline processes, improve employee productivity and improve the member experience.

Below is a health insurance CIO’s guide to emerging technology:

 

Chatbots and Virtual Assistants

Chatbots and AI-based voice assistants

What Is It?

Chatbots and AI-based voice assistants are text or voice-based interfaces that replace traditional customer service roles by delivering information about health plans to members. Chatbots are generally available on websites or mobile applications. AI-based voice assistants are frequently available to members who call an insurer for information and generally do more than just intelligently route calls. Instead, they answer commonly-asked questions and can even connect to member data to personalize experiences. They don’t replace customer service representatives. Instead, they free representatives from answering common questions and focus their energy on uncommon questions. Plus, you may be able to redeploy member service teams to proactive activities instead of reactive ones.

What are the benefits?

Chatbots and AI voice assistants allow insurers to scale customer service activities as well as connect data to chatbots and voice assistants to provide fast, personalized member experiences.

When Will It Arrive?

In 2018, Google showcased a Google Assistant feature that could book appointments at a restaurant in a remarkably human-sounding — and conversational — voice. With that, voice assistants became a reality. Though future advancements in artificial intelligence and machine learning could make them even better, Google’s prototype showed that natural-sounding voice assistants that could process human language in real-time had arrived.

Representative Solutions

Zendesk Support Suite, Intercom, AppyPie, Drift, Conversica, Ada, Ultimate.ai

Health Insurance Use Cases

Chatbots are already in wide usage throughout the health insurance industry with varying levels of complexity. They’re mostly used to deliver answers to members as well as route calls. But they can also be used in marketing and sales situations, like on a website.

 

virtual and augmented reality

Augmented Reality and Virtual Reality

What Is It?

Augmented reality adds virtual elements to the real world, often using a camera on a smartphone. Google Glasses were also an early augmented reality application, overlaying information on the real world. Virtual reality is a completely immersive experience usually attained using virtual reality devices like Oculus or Google Cardboard. Users can be transported to either a simulation of real-world environments or entirely imagined environments.

What are the benefits?

AR and VR enable easier information exchange as well as convenient service to members while helping surgeons and doctors better train, diagnose, operate and manage. Insurers, meanwhile, can leverage AR and VR to develop more member-focused tools by providing information to members that help them understand their diagnosis, interact with virtual doctors or member support representatives, and other uses

Realistically, today there are few applications of AR and VR for insurers, but the technology could significantly improve patient outcomes and streamline healthcare procedures. From surgeries that leverage more easily accessible patient information to treatments for common phobias that leverage virtual reality, AR and VR have an opportunity to significantly improve patient outcomes and reduce healthcare costs.

When Will It Arrive?

To a large degree, it’s here. Though more capabilities and solutions will likely hit the market in the coming years, the technology is here.

Representative Solutions

Aetna’s vHealth app, SyncThink headset, XRHealth, OSSO VR, Proprio Vision, Vicarious Surgical, Oxford VR, Karuna Labs

Health Insurance Use Cases

For health insurers, specific AR and VR use cases are sparse today, but value-added member services like virtual doctors or member support services offer an opportunity to create better more immersive member experiences.
Mobile Solutions

Mobile Solutions

What Is It?

Mobile solutions generally are phone applications developed by health insurers to improve the member experience.

What are the benefits?

Phone applications enable insurers to deliver a better member experience when those members are on the go. Custom-built experiences on the phone make it easier for members to enroll, review claims, find a doctor, estimate medical costs, access a virtual id card, compare medication prices, and more. Those mobile apps can help improve member satisfaction scores and retention rates. Plus, a phone app can include other emerging technologies — like the ability to contact a nurse in a virtual environment, interact with an insurer’s chatbot or virtual assistant, or integrate wellness data from a connected device — to create an even better member experience.

When Will It Arrive?

It’s here, but as phone capabilities and development software improve so will the opportunity to stack emerging technologies within an insurer’s mobile application.

Representative Solutions

Aetna Health’s app, UnitedHealthcare’s Health4Me app, myCigna, MyHumana

Health Insurance Use Cases

Mobile applications for members can help health insurers deliver a better member experience and put health plan information at their fingertips no matter where they are. There are also opportunities to deliver mobile apps to streamline processes for providers when submitting claims for payment.

 

robotic process automation

Robotic Process Automation (RPA)

What Is It?

As the name implies, RPA uses software “robots” to automate business processes. Those “robots” can process transactions, manipulate data and interact with other systems and software. The use of these robots can be simple — automating a response to an email, for example — or complex — leveraging hundreds of bots that can be programmed to automate jobs in an ERP system.

What are the benefits?

By automating business processes with technology, you’re generally saving money. You’re also freeing staff to work on more rewarding tasks because those best suited for RPA are repetitive, mundane tasks. Plus, you’ll save time. Software robots can generally perform work faster, as well, streamlining processes. Even better, advanced applications can leverage machine learning, artificial intelligence, and language processing to perform more complex work, increasing returns.

When Will It Arrive?

RPA is here, though generally it’s being used for lower-level tasks and by only about half of Enterprise businesses. And, though successes can be found, the early days of RPA saw a lot of failures. As RPA continues to evolve and mature, businesses will gain experience and build more elaborate RPA solutions. In sum, RPA is here, but as it matures it will have a greater impact on your business.

Representative Solutions

UIPath, Automation Anywhere, Blue Prism, WorkFusion, Olive, Pegasystems

Health Insurance Use Cases

There are an almost endless amount of transactions RPA can help automate within a health insurer. One payer leveraged RPA to quickly identify high-risk pregnancies and enroll members into the appropriate care management plan. You can use RPA to streamline the member enrollment process. RPA can streamline the prior authorization process. You can use RPA to extract data from disparate systems in real-time to help employees in your call centers answer questions faster. You can electronically process forms, including claims processing. All of these are examples of processes that can streamline your business and eliminate heavily manual, repetitive tasks.
Cloud Computing

Cloud Computing

What Is It?

Cloud computing delivers services like databases, storage, servers, software applications, data analytics, and other business information over the Internet.

What are the Benefits?

There are numerous benefits to moving your business platforms to the cloud. Cloud solutions generally eliminate the cost of hardware — both setting up and maintaining it. It’s easier to scale — cloud solutions today are more elastic, allowing you to increase resources like computing power, storage, or bandwidth — if needs demand. Security is generally easier to set up and maintain because the cloud provider delivers security resources as well as software updates and patches. Cloud solutions can be more reliable because most cloud providers include data backup, disaster recovery, and redundancy out of the box.

When Will It Arrive?

It’s here, but many health insurers aren’t taking advantage of cloud computing throughout their business. Many core admin systems are still server-based, not cloud-based. Many health insurers still rely on siloed, in-house, legacy systems that result in inflexible products and processes. Though other industries have embraced cloud computing, health insurers as a whole have been more hesitant in their adoption of cloud computing technology.

Representative Solutions

Amazon Web Services (AWS), Google Cloud, Microsoft Azure, Certifi, Evolent HealthAxis Group

Health Insurance Use Cases

There are several cloud computing use cases, from replacing legacy core admin solutions with best-of-breed, cloud-based, modular solutions to leveraging cloud-based data analytics solutions. Cloud systems are also generally easier to connect to other cloud platforms, making it easier for insurers to connect with providers, brokers, insurance exchanges, and other partners. In fact, Oscar built its entire health insurance platform on AWS in three months.
Predictive Analytics

Predictive Analytics

What Is It?

As the name implies, predictive analytics uses data, algorithms, and machine learning to make predictions about future outcomes.

What are the Benefits?

Generally, predictive analytics can help businesses make better decisions by analyzing data and determining what is most likely to happen in the future. So benefits could be financial if you’re predicting member actions or trying to determine what impact product changes will have on revenue. It could help identify members at risk for specific diseases and lead to early interventions that save money. It could predict member utilization patterns, enabling better staffing models that reduce member wait times and improve member satisfaction.

When Will It Arrive?

To some degree, it’s here. For many organizations, it’s a matter of having the internal resources available to identify applications for predictive analytics and then delivering the analytics techniques and models. Finding employees who can turn data into predictions can be difficult, so many organizations start by taking simple data sets, finding patterns, and making simple predictions.

Representative Solutions

IBM, Tableau, SAP, Teradata, TIBCO Software

Health Insurance Use Cases

Predictive analytics is most commonly used in sales and marketing applications. For example, insurers can leverage their member database to find attributes that are most likely to lead to enrollment in a specific Medicare Advantage program and then create marketing programs and focus sales activities on consumers who fit the typical enrollee. Insurers can also leverage predictive analytics to improve data security. By monitoring patterns in data access, sharing, and utilization, you may be able to predict when an intruder has penetrated a network. Another application would be measuring member interactions to determine when members have a low satisfaction score and intervene before they churn.
Internet of Things

Internet of Things (IoT)

What Is It?

The Internet of Things describes physical objects with sensors, software, and/or other technology connected to the Internet. IoT devices can include things like lightbulbs, smart thermostats as well as smartwatches, fitness bands, or other health monitoring devices. Some non-wearable monitoring devices — like ambient sensors that determine if someone has taken their medication — also fall under the IoT category.

What are the Benefits?

The primary benefits for health insurers revolve around the amount of member data that can be collected through Internet-connected health monitoring devices. IoT devices can deliver data that helps insurers better measure the health of their members — and intervene earlier to provide care. Those early interventions can have financial benefits for the member as well as the insurer. Insurers also benefit by developing more personalized experiences for members, delivering a better experience, and improving member retention.

When Will It Arrive?

It’s here in some forms. Many health plans are incentivizing members based on wellness goals. Some Medicare Advantage plans include some type of wearable or monitoring device. But it’s not yet a standard practice for insurers to collect advanced data from their members.

Representative Solutions

Apple Watch, FitBit, Amazon Echo, Glucose monitoring devices, Heart-rate monitoring devices, Connected inhalers, Ingestible sensors

Health Insurance Use Cases

In the future, it may be standard for insurers to use IoT monitoring devices to offer discounts or tailored pricing based on fitness activities that members perform or healthy behaviors they exhibit, similar to how auto insurers track driving behaviors and mileage to determine premiums. IoT devices can also help health insurers develop ambient assisted living products and services to help aging members live independently at home. IoT also delivers more personalized information about members, helping insurers better identify fraudulent claims.
Blockchain

Blockchain Data

What Is It?

Essentially, blockchain is a type of database structure. Blockchains are usually used to store a  digital ledger of transactions that is duplicated and distributed across a network of computer systems in what’s called a blockchain.  The most common use of a blockchain to store data is that used by cryptocurrencies like Bitcoin. Bitcoin uses a public blockchain, basically computers located around the globe that store every Bitcoin transaction. Private blockchains exist when all the computers storing data are operated by the same entity.

What are the Benefits?

Blockchain’s design makes transactions more secure. Because the data in the blockchain is distributed across multiple computers and secured with public and private keys, changing existing data in the blockchain is difficult. Blockchains also improve transparency. The distributed nature of blockchain means all participants on the blockchain network can see the same information at the same time. Members on the blockchain can see the entire history of transactions because transactions are time and date stamped and difficult to modify.

When Will It Arrive?

Today, a limited number of health insurers have deployed practical blockchain applications. Realistically, it will likely be five to ten years before a significant number of insurers have made significant investments in blockchain technologies.

Representative Solutions

BurstIQ, Medicalchain, GemOS, HSBlox

Health Insurance Use Cases

The most common use cases for health insurers revolve around identity management. That ranges from improving security for patient data, making it easier to share records and identities across insurers, providers, and researchers, and simplifying provider demographic data. However, advanced use cases could include claim submissions, claim adjudications, and prior authorizations.
Low Code Applications

Low Code

What Is It?

Low-code development platforms leverage visual interfaces with logic and drag and drop features instead of extensive coding languages. Gartner predicts that by 2023, 53% of medium to large enterprises will have adopted a low-code application platform as one of their strategic application platforms.

What are the Benefits?

Low-code platforms improve time to market and make it easier for employees to build basic applications or workflows without programming language knowledge.  Because you can leverage employees throughout the organization instead of developers to create applications, the cost of building an application may be decreased. Insurers can also conceive and build low-code applications to automate business processes much more quickly than bringing in development resources. Plus, low-code applications can reduce the maintenance burden from your development teams. Ultimately, low-code applications can free your development team to work on more complex projects and development, while enabling your business units to create their own simple applications, improving productivity for developers and streamlining business processes.

When Will It Arrive?

Few insurers are using low-code products today to develop applications, but within five years low-code applications will likely be more readily used in health insurance businesses.

Representative Solutions

Salesforce, Microsoft, Appian, ServiceNow, Mendix, OutSystems, Boomi

Health Insurance Use Cases

Common beginning uses for low-code solutions include integrating data from disparate systems to create analytics dashboards. Since insurers typically are leveraging information from disparate systems, a good use case is generating APIs. Low-code API generators exist that can quickly build APIs based on existing application code. Insurers also leverage low-code platforms to create member-facing data interfaces with legacy backend systems. Member or customer service interfaces, in general, offer opportunities to deploy low-code products for user interface development.

 

Certifi’s health insurance premium billing and payment solutions help healthcare payers improve member satisfaction while reducing administrative costs.

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