Deep Dive: Artificial Intelligence for Payer Use Cases

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

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• Related Research

• Synopsis