Humanizing Payor-Provider Interactions: The Role of AI
Introduction
Artificial Intelligence (AI) can transform healthcare payor-provider interactions, making them smoother and more natural. But for this transformation to happen, IT leaders need to team up with systems integrators who have the right AI skills and tools.
Why AI is Needed in Healthcare Payer Systems
Healthcare providers want fast and accurate processing of authorizations, claims, and payments. Right now, they're bogged down by old methods and lots of paperwork. On the other hand, healthcare payer IT leaders struggle with big, slow, and costly processes, making it hard to modernize these interactions and comply with regulations.
AI capabilities can simplify both the front-end (what the provider sees) and back-end (data processing) work. This modernization can start with two main steps.
1. Prioritize Tasks for AI Transformation
Every provider application has many tasks, like checking eligibility or submitting claims. A value-risk matrix helps IT leaders find out which tasks are best suited for AI, like an AI-powered eligibility check or a GenAI claims agent. This matrix also helps get support from top management.
An experienced systems integrator can help identify these tasks quickly. After identifying, the AI platform can be tailored to these specific tasks. New AI capabilities can then be built and deployed, such as cognitive searches, cloud-native services, and business copilots.
These targeted AI projects pave the way for future advancements. Instead of text-heavy web portals, soon providers or members will ask simple questions and get direct answers from GenAI copilots. These AI copilots can also proactively send updates, alerts, and reminders.
2. Create a Unified Data Foundation
Successful AI needs lots of high-quality data. Existing data processing must be updated to support this. A trustworthy data foundation is crucial for long-term AI success, and this should be a top priority for healthcare IT leaders.
The good news is that AI tools can make building this modern data foundation easier and faster. A proven method for creating this foundation can be applied. GenAI agents can help IT teams identify old apps and their data. AI agents can then create and manage new data processing applications. Data can gradually move to a cloud-based data lake, with AI agents managing it. All these capabilities are provided as cloud services.
Conclusion
AI tools enable healthcare payer IT leaders to modernize both provider applications and the backend data systems. AI simplifies the portal experience for providers and members, making it more human-like. AI-powered application development and data management tools, available through cloud services, smooth the path to a trustworthy, unified data foundation.
