It’s no secret that the cost of health insurance has increased significantly over the past decade. According to the Kaiser Family Foundation (KFF), average family premiums increased 20% from 2017 to 2022 and 43% from 2012 to 2022.
With this in mind, health insurance companies are turning to technology to find ways to not only keep their members healthy, but also reduce costs.
“Innovations pave the way for a simplified member experience, enabling faster and easier access to health information and enhanced member communications,” said Mike Muñoz, Market President, AmeriHealth. Masu. He added that AmeriHealth is taking a digital-first approach to communicating with members to educate them about their benefits and support access to care.
As the world becomes more digital, being able to access services such as guidance about your health care becomes important. Old systems simply lack effective communication, which can lead to poor outcomes and high treatment costs.
“We have the technology infrastructure in place to customize outreach to our members based on their engagement with the health care system, such as recent diagnoses and hospital discharges,” Muñoz said. “We are combining digital messaging with personal contact. We know that AmeriHealth members appreciate being able to connect directly with a health coach to answer their questions and support their decision-making. We are proud of this approach and are an example of how we respond to advances in technology while prioritizing the needs of our members.”
“Health insurance is making great strides in providing access to health care through new technologies,” said Jill Daly, vice president of commercial products at Aetna. “For example, most payment providers are exploring ways to leverage both large-scale language models and new generative artificial intelligence (AI) systems to help customer service agents arrive at the right answers faster and easier. I’m looking into it.”
MUnoz says a responsible approach that leverages generative AI could help further personalize member communications in the near future.
Utilization of data
Properly leveraging powerful data and analytics certainly appears to be the key to improving patient care and reducing costs. Muñoz said data and analytics can be used in a variety of ways, including: Promote the development of value-based care arrangements with providers. For example, it can be used to inform pharmacy management programs to promote compliance and appropriate drug use.
Additionally, Muñoz said AmeriHealth uses predictive modeling and population health management programs to identify high-risk members and target them with interventions that can improve and prevent certain health conditions.
“This ultimately reduces costs, but more importantly improves member happiness,” he added.
“The best way for insurance companies to use data is to help people get the most out of their insurance benefits, with the goal of both reducing costs and improving health,” Daly says. “Proactive, data-driven guidance is critical to helping consumers manage their health care costs. For example, if an elective procedure is needed, avoid potential expenses associated with out-of-network treatment. To avoid this, we want to recommend high-quality providers in our network.”
Daly says data can also help provide guidance after the fact. “If someone is in an emergency room and their issue could have been resolved virtually, we educate them about virtual care options and the potential savings of using that model in the future. ,” she explains.
virtual health
The increasing adoption of telemedicine also creates opportunities for cost reduction.
Muñoz said AmeriHealth saw a 14,391% increase in telehealth visits from 2019 to 2020, and usage remains strong.
“Virtual care is a powerful way to expand access to care,” Daly said. “Geographic barriers that limit access to providers are removed, and some people have options that may be a better fit for their lifestyle.”
Muñoz explains that telemedicine is a definite complement to in-person visits. “For example, virtual primary care visits can lead to earlier treatment of health conditions for members who do not seek in-person care, reducing the risk of complications and the need for urgent care. It could ultimately lead to cost savings,” he says.
