TECH BUYER Jan 2023 - IDC Perspective - Doc # US49995322

Deep Dive: Artificial Intelligence for Payer Use Cases


Jeff Rivkin
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


Service Clinical Review

Coordination of Benefits


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


Data Privacy


Ethical/Equity Concerns

Intellectual Property

Advice for the Technology Buyer

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