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Unlocking the Promise of AI in Member-Centric Care

Improving the customer experience is no longer an idea that’s relegated to the retail or hospitality industries. Now, the idea has gained traction across many industries, including healthcare. For health plans, improving the customer experience and providing member-centric care helps drive member acquisition and retention and improve reimbursement (via a better STARS rating).

With so many benefits at their fingertips, why haven’t the majority of health plans become member-centric yet? Unfortunately, it’s not that easy. Health plans need to engage both members and providers to deliver on an approach to member-centric care. However, recent developments in artificial intelligence and its applications in healthcare could provide new options for health plans looking to improve their efforts in providing member-centric care. They include:

  • The orchestration of the patient journey: In ZS’s AI in Healthcare survey, we found that the majority of the patients (67%) feel positive about AI helping to improve the overall efficiency of healthcare. From a health plan’s perspective, it means leveraging AI to better orchestrate the patient journey. This could include a data-driven way to help members pick the right coverage, find a relevant provider, make an appointment, connect to a pharmacy, etc.
  • Access to care: Receiving care outside of the doctor’s office is gaining traction, and AI can help take it further. Our survey finds that 22% of physicians work in an organization where patients can interact with a physician virtually through a telehealth platform or an application, and 45% of the patients surveyed have received care outside of the doctor’s office through devices such as computers, tablets and smartphones. Along with improving member experience, by expanding channels of care, telehealth platforms are a great way of improving utilization.   
  • Active health management: Our survey reveals that 45% of the patients use wellness apps that track overall health and future goals. In addition, 34% of patients use wearable devices that aid or monitor daily activity to improve health and wellness. Artificial intelligence can enhance the use of wearables by providing better insights and monitoring chronic conditions in a smarter way, helping plans make their population health management initiatives more effective

With AI, health plans now have a new tool to improve the customer experience, but there are a few challenges that they will have to overcome to unlock the full potential of AI in member-centric care.

  • Access to data: The effectiveness of an AI algorithm depends on the quality and diversity of data. Health plans need access to patient data, and the biggest challenge that patients see in AI-driven healthcare is data security, according to ZS’s study. This means that plans will have to address data privacy concerns while thinking about their AI strategy.     
  • Trust: ZS’s survey also found that patients trust providers more than plans when it comes to sharing their medical and personal data. This is a tricky problem but one that plans need to solve if they want to be on the leading edge of leveraging AI in member-centric care.
  • Skill gap: AI expertise is isolated from the owners of the data (the payers). This might be more applicable to small- and mid-tier insurers as some of the bigger insurers have good in-house capabilities. The plans that don’t have the right AI capabilities will have to put a strategy in place to overcome the expertise gap. These plans will have to decide whether to build capabilities in-house, partner or acquire companies with AI capabilities. The decision will depend on the current expertise, size of the organization, and the organization’s vision about its core competencies.

For more on the benefits of leveraging AI to improve member centricity—and four steps that health plans can take to get started with AI—check out our white paper, “Unlocking the Promise of AI in Member-Centric Care.”  

This article was created in collaboration with the sponsoring company and our sales and marketing team. The editorial team does not contribute.
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