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How AI can cut health care costs

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Companies spend a fortune to provide health insurance for their employees. In the U.S., 57 percent of all people get their health care through an employer-provided plan. In the past 10 years, employers have seen their costs increase over 63 percent, and costs are forecasted to grow at three times the inflation rate for the foreseeable future. Companies have begun shifting more of these costs to employees. The use of high-deductible health plans (HDHPs) by companies of all sizes just passed the 50 percent mark. Employees’ personal health care expenses is forecasted to grow four times faster than wages.

For companies,  one of the basic problems with health insurance is that it’s like giving your employees a credit card and sending them to a restaurant that doesn’t have any prices. We shouldn’t be surprised when people order the steak and lobster. Companies are realizing that if they want to control costs, they need to help employees reduce the volume and size of their claims. Companies are no longer satisfied with a health advocacy phone number that gets lost in an employee’s benefits package. Solutions need high utilization to affect claims.

Simplify insurance documentation

Dealing with your health insurance is difficult. A survey by PolicyGenius found that just 4 percent of Americans are able to correctly the terms that determine how much they have to pay for medical service. Artificial intelligence, big data, and chatbots are arriving to solve these problems.

Every year, people get new plans that come with a few large documents. You’ll usually receive a summary of benefits, a policy booklet (mine is 156 pages), a list of prescription benefits, a doctor directory, a participating pharmacy list, maybe even a dental and vision benefits booklet. It’s information overload, and if you don’t understand everything, it can cost you dearly.

Seek out prescription savings

Prescription drugs is another area that’s ripe for savings with this technology. Rising drug costs now account for 15 to 25 percent of the cost of your health insurance. The crazy thing is that since drug formularies vary from plan to plan, your doctor doesn’t know the cost of a medication she prescribes you. I remember my shock when I went to the pharmacy once and was told the bill was going to be over $1,000. I quickly called my doctor and found an alternative that cost only $4. Seriously, only $4. It’s not the doctor’s fault — there are almost 7,000 drugs approved by the FDA for sale, and plan formularies vary so much.

AI can take into account many thousands of data points, including plan formularies, therapeutic alternatives, generics, coupons, pharmacy pricing (it can vary widely), pill splitting, mail-order options, and more. Prescription benefits is a problem that’s perfect for artificial intelligence to tackle and provide recommendations for savings.

Price out procedure costs

Procedure costs is another area suited for chatbot and AI assistance. A study that analyzed data from Blue Cross and Blue Shield found that the cost of the same medical procedure could vary by as much as 313 percent within the same city. The worst part of all of this is that if you even try to shop around for a procedure, you’ll get the answer “I don’t know” way too often. Pricing is often only given after you get the service. With a chatbot, it’s easy to ask a question about price and get an answer within a short time.

There are so many problems to target with artificial intelligence within the employee health benefits space, it’s staggering. Health care is 17.8 percent of the entire GDP of the United States, according to Centers for Medicare and Medicaid Services stats, and there are thousands of niches to use technology to increase efficiencies. There is a steep learning curve in entering the space, but plenty of opportunities.

Rick Ramos is the chief marketing officer for HealthJoy.com, a cost containment platform for employers to manage their health care.

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