Intelligent health insurance

Photo of Stefan ButtigiegStefan Buttigieg, MD
December 15, 2017
... min read

The future of health insurance is here. I have been exploring the various ways the triage experience is being reinvented.

At a glance:

You feel unwell so you open your health plan’s App. This app has a symptom checker, and it has the all the latest updated information about you. You answer some relevant and targeted questions based on your symptoms, and the app recommends a teleconsultation on the same day. You get the call from a qualified health professional, who asks you specific questions and suggests that you start on specific medication which has a high success rate based on your latest genetic profile. The electronic prescription is transmitted to your nearest pharmacy, which offers to deliver the medicine through their on-demand courier service.

Just 20 minutes later, you receive a notification on your smartwatch informing you that the courier has arrived with the medication. You open your door and the courier hands you a sealed package with a unique physical code, which you unlock after receiving a secure code from your health plan’s app. A week later you receive a notification from your health plan’s chatbot app asking how you feel, and you are happy to reply, ‘Yes I am better’. This is the kind of revolution that health insurance companies must adapt to.

The case scenario described above is the evolution that will take place in the healthcare encounter as a result of the growing use of the internet and its role in nearly every aspect of everyday life. Doctors are being overexposed by growing inquiries from patients and they lack human resources. In fact, one in five UK residents wait a week or more to see a GP. For this reason doctors need actionable solutions which allow them to spend quality time with the patients who need it the most.

AI for personalized health insurance

Matching the right health intervention to the right patient is the crux of the future of health insurance. This is how we make optimal use of limited health resources. According to a recent report by Accenture Consulting, key clinical health AI applications can potentially create 150 billion dollars in annual savings for the US healthcare economy by 2026. In an ever-increasing restrictive health care financing environment, with WHO seeking to achieve Universal Health Coverage by 2030, Artificial Intelligence presents an opportunity to create a paradigm shift.

Malta-based Insurance Startup Sherpa with their slogan “Insurance, now it’s personal”, provides the customer with the opportunity to connect the system to their personal data and upload existing insurance policies. This results in the development of a personalised risk assessment, based on which Sherpa makes recommendations for optimizing your insurance expenditure with no paperwork. Furthermore, they claim that this will not be just a one-time process, but life-long.

“AI applications can potentially create 150 billion dollars in annual savings for the US healthcare economy by 2026.”

But isn’t health insurance all about being prepared for when that health emergency happens? Is this only happening within the health insurance industry?

Intelligent health – the reinvention of insurance

“Let the healing begin” – this statement empowers the mission of Oscar Insurance, a technology startup which has reinvented health insurance. They even offer concierge care teams and direct scheduling from your smartphone.

This startup has built their core business by extracting insights from an abundance of existing healthcare data, such as insurance claims, doctor directories, and electronic medical records. They have excelled at connecting the patient with not just any specialist, but the right specialist. Oscar is not the only startup using data to draw insights for health insurance.

Dreamquark, with their team of former particle physicists, used their expertise of large dataset analysis and efficient algorithm design to revolutionize the way data analysis is performed in the insurance, financial services and healthcare sectors. They have developed deep learning models which not only provide solutions, but explain the process by which a decision was reached. This is crucial, especially in an advancing medical world geared towards evidence-based and personalized medicine.

The latest Symptom Checker released by Allianz Worldwide Care shows how Artificial Intelligence is steadily percolating through the insurance industry with valuable insights on patients’ information needs. The information needs of patients and the insights required by the insurance company have the potential to create a sustainable, long-term relationship.

Decoding insurance claims and medical fraud

AI can help insurance companies and third-party entities in processing insurance claims by verifying data, checking for errors, and more.

This is not the only chat-enabled service; we recently discovered HealthJoy, a startup focused on reducing healthcare costs. The startup genuinely believes that healthcare is best delivered as a conversation, and their chatbot, charmingly named “Joy”, has been perfected to deliver a wide variety of services such as telemedicine, therapeutic alternatives and lab services. They even have a doctor available 24/7 free of charge through their app, specifically for employees. This kind of communication saves crucial time and resources lost in situations such as unnecessary middle-of-the-night visits to healthcare services. Visits to the Accident and Emergency department can be quite costly!

The future of insurance

The three trillion dollar global insurance industry, with its troves of data, is a clear opportunity for healthcare and insurance industries to undergo a radical transformation. From a practical point of view, the crucial aspect of the insurance business which is the claims process is ripe for reinvention and could hold the key to better health insurance for everyone.