AI Is Changing Healthcare for Providers and Payers


Artificial Intelligence (AI) cannot offer a physician’s personal touch, but there are many tasks it performs better than any human can.


Artificial intelligence (AI) has been around for decades, and it has current and potential applications for almost every sector — from Siri and Alexa to customer service chatbots and advanced facial recognition. Some of its most promising applications are in healthcare — in the delivery of care and in the insurance arena. Payers already use it to improve coding processes and help their customers choose the right insurance plan. AI has extraordinary potential, but like anything else, it’s not without its downsides.

Understanding AI

AI has a mysterious, even sinister, reputation — most of which comes from science fiction. But the myriad fictional versions of AI have little to do with the reality. Artificial intelligence is a specialized branch of computer science focused on creating technology to perform tasks that normally require human intelligence. AI algorithms are designed to analyze and draw conclusions from massive amounts of data — activity typically too difficult and time-consuming for humans. The technology can then learn from and build on those conclusions to draw further conclusions or apply them directly in a practical application.

AI tools are increasingly important for health insurance companies. It’s a key contributor to the industry’s ongoing digital transformation. In claims processing, for instance, AI tools streamline the workflow to review a claim, verify its details against the policy, and run the claim through fraud detection — all in a matter of seconds. This next-level efficiency lowers costs and improves payer relationships with patients and healthcare providers.

Insurance companies can also use AI to customize health plans to individuals, or develop cost estimators to help individuals and companies understand and consider their options. AI can even collect and analyze data to target marketing campaigns or allow chatbots to engage with patients and address their benefit questions. Healthcare providers share in the benefits of AI-enabled claims processing. AI tools can also reduce provider workload — and burnout — by taking on administrative tasks and extracting data to streamline coding and billing. AI makes everything easier on payers, providers, and patients, so what’s the catch?

Challenges of AI in healthcare

With all the advantages AI offers, it’s not without its challenges. AI implementation can raise a variety of potential issues, including:

  • Cost. AI technology will eventually pay for itself many times over, but the initial investment can be prohibitive. Establishing the technology infrastructure and getting personnel up to speed can be expensive in terms of time and money.
  • Ethics. AI bases its conclusions and decisions entirely on the data it’s given, so it’s essential to ensure the data an AI processes is unbiased and objective. It’s also important to note that technology is incapable of empathy. Decisions affecting human well-being involve factors beyond what data and AI algorithms can address.
  • Security. Cybersecurity is probably the biggest potential concern with any new technology — as all the recent high-profile data breaches and ransomware attacks illustrate. AI accesses a lot of data — some of it sensitive and protected by privacy laws — and malicious actors view that kind of access as an invitation. Strong cybersecurity measures are essential for the technology and the human beings who interact with it.

AI will undoubtedly play an increasing role in health insurance — and healthcare — going forward. Understanding how to use it, its pros and cons, and the best practices that make it beneficial is essential to successful and effective digital transformation.

Contact TruBridge to learn more about AI tools and digital transformation for claims processing and revenue cycle management.

Written by Brandon Hayes
TruBridge Executive Director

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