Panelists from Emerge Innovation Experience in Himss25 are from the left: Edward Marx from Marx consulting; Aric Pointed of Clover Health, Khin-Kyemon Aung of Scan and Heather Lavoie from Horizon Bcbs from Modern Jersey.
Photo: Susan Morse/Healthcare Finance News, Himss
Las Vegas – because AI transforms all aspects of healthcare, this affects the care model for payers.
Health insurers have total visibility in individual needs of care and patterns of operate among suppliers and settings.
Virtual care, technology and artificial intelligence have helped payers to determine a more lively role in providing care.
The barriers include resistance before the changes and the lack of better adaptation of the payer and the supplier, the panels say during the first Innovation experience in Himss25.
Edward Marx, general director of Marx Advisory and former Global Information Director at Cleveland Clinic, moderated the Panel of Experts from Clover Health, Scan Health Plan and Horizon Blue Cross Blue Shield of Modern Jersey and Humana.
The session “Voices of Innovation: Transforming Healthcare in a world based on the payer” reflects the title of the book “Voices of Innovation-Payers”, co-edited by Marx and Sakshika Dhingra, director of the Medical Strategy for Humana.
Clover Health has developed AI power technology, which allows its operate of enormous data sets and starting algorithms to assist in early diagnoses and better results, said Aric Pointed, a CEO of care based on values in Clover Health.
“We culturally encourage everyone to use AI,” said Pointed. “The basis of our focus is care.”
Solutions for most payers are now AI and Chatbox assistants that can improve members’ interactions.
Members want information quickly, said Heather Lavoie, information director and Vice President for Enterprise Operations for Blue Cross Shield Modern Jersey. She said that one of the pain points for patients is to call them the insurer.
“People don’t want to call us,” said Lavoie. They want answers, she said.
A more automated approach helps in staff turnover, said Khin-Kyemon Aung, senior health care director, medical director and primary care doctor for a scan.
Lavoie said it is hard to find people to work at a call center. AI can be used to sum up information about what is covered. This makes it easier for people to work at a higher level.
“We ask people to do the same job, but do it more effectively,” said Lavoie.
AI also helps for larger purposes, such as allowing the correct marking of outgoing connections so that managers can implement stratification, and nurses can properly attack cases according to the disease.
She said that she was used for voice interpretation in patients with Parkinson’s disease.
Aung said that the scan began to cooperate with Cresta. The Contact Center contact platform powered by AI provides real -time automation and guidelines for chat agents during navigation of convoluted care conversations.
“He listens in the background,” she said.
Aung said that directly to AI Consumer makes it easier for members, although there are real basic reasons that AI cannot miss.
“AI is an accelerator of all these other technologies,” said Lavoie. “We are excited about technology.” .
She said that the plans focused on claims, but there is a lot more, including information about members’ preferences.
“We enter sensors, health risk assessment to create better members’ profiles,” said Lavoie.
At the moment AI is used to approach healthcare, according to Pointed.
“We must think about breaking the way in which the system works in its entirety,” said Pointed, even suggesting that “revenue cycle can change if we look at completely different models.”
Pointed said that one of the biggest barriers to innovation is culture and people who want to remain rooted.
Aung mentioned the challenge of adjusting the payer and supplier.
Pointed said that payers and suppliers would solve problems in different ways. He said that it was needed to enter the same page and have one path.