It is no secret that the cost of health insurance has increased significantly over the past decade. According to Kaiser Family Foundation (KFF), the average family insurance premiums increased by 20% from 2017 to 2022 and 43% from 2012 to 2022.
With this in mind, health insurance companies are looking to technology to find ways to not only keep their members healthier, but also reduce costs.
“Innovation paves the way for a simplified member experience, enabling faster and easier access to health information and enhanced member communication,” says Mike Munoz, market president at AmeriHealth. He adds that AmeriHealth has adopted a digital-first approach to member communications in an effort to educate them on their benefits and support them in accessing care.
As the world becomes increasingly digitized, the ability to access services such as guidance about one’s healthcare becomes critical, as the antiquated systems of old can lead to worse outcomes – and more expensive care – due simply to a lack of effective communication.
“We have the technology infrastructure to customize outreach to members based on recent diagnoses or engagements with the healthcare system, such as a hospital discharge,” Munoz says. “We pair digital messaging with personal contact. We know AmeriHealth members appreciate that they can connect with health coaches directly to answer questions and support with decision making. We’re proud of this approach, which is one example of how we are keeping pace with technological advancements while prioritizing our members’ needs.”
“Health insurance is making great strides in offering access to healthcare via new technologies,” says Jill Dailey, vice president, commercial product at Aetna. “For example, most payers are exploring ways to leverage both large language models, as well as new generative Artificial Intelligence (AI) systems to help customer service representatives get to the right answer quicker and easier.”
Munoz says that a responsible approach to leveraging generative AI can help unlock further personalization of member communication in the near future.
Proper leveraging of powerful data and analytics certainly appears to be a key to improving patient care and reducing costs. Munoz says that data and analytics can be used in a variety of ways including: to detect fraud, waste, and abuse; drive the development of value-based care arrangements with providers; and be leveraged to inform pharmacy management programs to promote adherence and appropriate medication use, for example.
Additionally, Munoz says that AmeriHealth uses predictive modeling and population health management programs to identify and target its high-risk members for interventions that can improve and prevent certain health conditions.
“This ultimately lowers costs, but more importantly improves members’ well-being,” he adds.
“The best way insurance companies can use data is to help people get the most out of their benefits with the goal of both lowering costs and improving health,” Dailey says. “Proactive data-driven guidance is important for helping consumers manage healthcare costs. For example, if you need to have an elective procedure, we want to recommend a high-quality provider within our network to help avoid the potential expense associated with out-of-network care.”
Dailey says data can also help to provide guidance after the fact. “If someone goes to urgent care and the issue could have been resolved virtually, then we can remind them of their virtual care options and the potential savings of using that model in the future,” she explains.
The rise in telemedicine adoption has also led to opportunities for cost savings.
Munoz says that AmeriHealth has seen a 14,391% increase in the number of telemedicine visits from 2019 to 2020, with usage remaining strong today.
“Virtual care is a powerful way to expand access to care,” Dailey says. “It removes geographic barriers that limit provider availability, and it provides an option that some might find to be a better fit for their lifestyle.”
Munoz describes telemedicine as a reliable complement to in-person care. “Virtual primary care visits, for example, can lead to earlier treatment of health conditions for members who might not seek in-person care, reducing the risk of complications or the need for emergency treatment. This can lead to better health outcomes and ultimately reduced costs,” he says.
From a cost perspective, Dailey says that expanded telemedicine access can help in two ways.
“One way is by using a lower cost model to address a healthcare need – the best example of this is an individual using on-demand virtual care visits instead of going to urgent care or the ER,” she says. “The second way is by helping make sure people are receiving appropriate and timely care that they would not have gotten otherwise. That is a short-term increase in costs, but it’s a long-term investment in someone’s health, which will lead to reduced costs in the future.”
Overall, the space is rapidly evolving, and health insurance companies will continue to evaluate telemedicine policies to ensure they are meeting members and providers’ needs.
As the sheer amount of data available mounts, protecting that data, especially in the sensitive healthcare setting, is paramount.
Horizon Blue Cross Blue Shield, for example, has taken extra steps to ensure members’ security and privacy through implementing a Privacy Center of Excellence and a newly-created Data Ethics Commission. The commission reviews all data-related issues that could adversely affect members, such as practices related to collecting, using, holding and deleting data.
“Our employees are trained to maintain your private information in the strictest confidence,” says Carrie Parikh, chief privacy officer, assistant general counsel at Horizon. “And, when we do share information, we take steps to ensure that the recipients take privacy and security as seriously as we do.”
Beyond employee training, Parikh says Horizon also maintains administrative, technical and physical safeguards to reasonably protect members’ private information.
Finding new ways to leverage technology and take advantage of digital innovation will continue to spark opportunities to reduce the cost of healthcare.
One of these opportunities includes new dynamics when it comes to the relationship between healthcare providers and insurance companies.
“For instance, we recently partnered with Virtua Health to leverage their mobile mammography van,” says Munoz. “This enhances access to preventative screenings and helps us meet our members where they are, but ultimately, preventative care can help eliminate costly care down the line. We’re excited to find ways to deliver these solutions to members.”
“Making healthcare easier to access and understand is good for the health of individuals and the country. We need to always be on the lookout for how technology can help us get there,” concludes Dailey.
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