Table of Contents
Executive Snapshot
Figure: Executive Snapshot: Deep Dive — Artificial Intelligence for Payer Use Cases
Situation Overview
Digital Patient Experience
Preventing Adverse Drug Events
Prescription Benefit Management
Medication Adherence
Chronic Disease Management/Alerting Providers to Patient Deterioration
Population Health
Early Disease Identification — Identifying Undiagnosed Conditions and Intervention Support
Population Risk Modeling/Stratification
Digital Administrative Experience
Prior Authorization
The Triage Engine
The Authorization Automation Engine
Conversational AI
Sales Center Conversational AI
Service Center Conversational AI
Call Routing
Claims Settlement
Fraud Detection/Payment Integrity
Billing
Service Clinical Review
Coordination of Benefits
Underwriting
Enrollment — Personalized Health Insurance Policies
Adoption of AI in Payer Organizations
Figure: AI Spending in Related Health IT Areas
Figure: AI Deployment Priorities
Drawbacks of Using Artificial Intelligence in Health Insurance
Interpretability
Data Privacy
Security
Ethical/Equity Concerns
Intellectual Property
Advice for the Technology Buyer
Learn More
Related Research
Synopsis