🤩 AI-mazing Insurance

Good morning! 

Welcome to Healthcare AI News, your weekly dose of the latest developments and headlines in the world of healthcare AI.

In this issue, we explore the Digital Disruption of Health Plans, Biden's take on AI, a DNA ‘Parasite’ may have fragmented our genes, and five CIO's take on what the next generation of EHRs will look like.

Be sure to read on to see this week's Top headlines, Industry, Tech, and M&A news.

Let's dive in.

HEADLINE ROUNDUP

• Biden says tech companies must ensure AI products are safe (Read more)

• When Healthcare is decided by algorithms, who wins? (Read more)

• Improving Veterans’ inpatient experience through Virtual Reality (Read more)

• Stanford's 2023 State of AI in 14 Charts. A snapshot of what happened this past year in AI R&D, education, policy, hiring, and more. (Read more)

• The Coalition for Health AI (CHAI) unveils blueprint for trustworthy AI in Healthcare (Read more)

• Open AI 'Our approach to AI safety'. Ensuring that AI systems are built, deployed, and used safely is critical to our mission. (Read more)

• J&J unit files for second bankruptcy to pursue $8.9 billion talc settlement (Read more)

• AI chatbots can diagnose medical conditions at home. How good are they? (Read more)

• AI 'fairness' research held back by lack of diversity (Read more)

• AI cough monitoring can change the way we diagnose disease (Read more)

• A sensor that might someday enable mind-controlled robots (Read more)

💡 Keep reading to catchup on Industry, Tech & Deal flow

THE FEATURE

Digital Disruption of Health Plans

The health insurance is in various stages of a massive shift from physical to digital processes – introducing a myriad of opportunities to use AI-fueled enhancements.

In America, at least 15% of adults ages 19-34 are still left uninsured, whether through commercial policies or Medicare/Medicaid programs. In spite of the ACA Marketplace and expanded Medicaid in several states, about 11% of people with income levels below the poverty line still can’t qualify for assistance or afford coverage.

While the insurance coverage situation in the U.S. is complex, and policy decisions definitely play a part, AI and machine learning are being used to reduce the rising costs of health insurance. The overall landscape of claims processing is in the middle of a monumental shift, from physical to digital processes revealing many opportunities for AI and automation.

The Future of AI in Healthcare Coverage

In 2019 (pre-pandemic), private health insurance spending in the U.S. reached nearly $1.2 trillion. The market is huge, and very competitive – making it very attractive for large companies to invest in technology that gives them a competitive edge.

Insurance companies are focusing their efforts on three strategic priorities involving AI:

Fraud detection

Insurance fraud costs Americans a shocking $309 billion each year, according to the Coalition Against Insurance Fraud. That adds up to nearly $1,000 for each insured consumer.

Fraud detection is typically a manual, paper-heavy workflow which is slow and inefficient. AI can be used to develop NLP-based models that reduce the time needed to identify fraudulent claims by 75% - saving large amounts of administrative costs that trickle down into customer premiums.

Customer Service

AI-driven chatbots are becoming more common for all types of customer service applications, including health insurance. Deloitte estimates that 75% of all customer service requests can be automated through the use of chatbots. The ROI on this type of technology is clear – with up to a 40% reduction in costs related to customer service. Another motivator for using chatbots is the difficult labor market. Employers are simply finding it difficult to find customer service agents, and wages are on the rise. Chatbots can be trained specifically for health insurance applications.

Some of the current processes involving chatbots:

• Extract data, such as name, residence, age, symptoms, nutrition, physical activity and offer new customer policy estimates.

• Sending insurance claims documents like First Notices Of Loss (FNOL) and verifying claims progress.

• Interacting with customers on mobile apps to answer questions about digital claims.

Reducing Claims Costs

Preventative care to encourage healthy lifestyles is one way that insurance companies have always sought to reduce costs and lower premiums. AI gives them even more tools to work towards this goal. By integrating AI and IoT technology, insurance companies can reward customers for integrating their smartwatches or fitness trackers and maintaining healthy activity. A similar strategy has been used in the automotive insurance sector to track driving habits and associated risks.

Insurance companies are also using AI to process consumer data to tailor and customize coverage. Many consumers carry health insurance with benefits they will never utilize or do not have enough coverage in areas that they truly need. By using AI, companies can analyze an individual’s needs based on historical data and current health conditions, thus tailoring a product that best fits individual needs. When this strategy is widely used across plan groups, the overall cost of the group is decreased through more efficient underwriting, thus creating lower costs across the board.

AI, like all technology, is not without challenges!

Although AI is exciting and opens up tremendous opportunities, insurance payers should maintain a cautious approach.

Keep in mind the following standard precautions, and you will be in good shape to begin the AI journey:

1. Protect patient data at all costs. AI algorithms must “learn” from large pools of data. These massive, stored datasets must have robust cybersecurity protections in place to guard against hackers – an unfortunately common issue these days. HIPAA compliance is crucial.

2. Ethical issues. Although AI is perceived as unbiased because it comes from a computer – it is only as good as the source data. It is essential that companies understand the rules behind the application’s processes, considering that there is still a possibility that mistakes can happen.

For the health insurance industry, AI is playing a major role in how business is done. AI technology is constantly improving and is poised to change the industry for the better.

INDUSTRY NEWS

• What to do about AI-Driven job displacements (Read more)

• FDA issues draft guidance on predetermined change control plans for AI/Machine learning-enabled medical devices (Read more)

• Millions set to lose Medicaid coverage as pandemic-era rule expires (Read more)

• People are using ChatGPT for therapy. Here’s what Mental Health experts think about that (Read more)

• Scientists find antibiotic-free way to treat drug-resistant infections (Read more)

• How a DNA ‘Parasite’ may have fragmented our genes (Read more)

• AI tool helps clinicians to identify and treat lung cancer at their early stages (Read more)

• The role of AI in addressing the maternal health crisis (Read more)

• Are employers picking affordable healthcare benefits? (Read more)

• Is AI better at assessing heart health than sonographers? (Read more)

• A genetic breakthrough in the battle against age-related vision Loss (Read more)

TECH NEWS

• Microsoft leaders on cybersecurity: ‘Healthcare is very vulnerable’ (Read more)

• Google CEO Sundar Pichai promises Bard AI chatbot upgrades soon: ‘We clearly have more capable models’ (Read more)

• Machine Learning (ML) vs Artificial Intelligence (AI) — Crucial Differences (Read more)

• What will the next generation of EHRs look like? 5 CIOs weigh in (Read more)

• Planning a data strategy for training Healthcare AI applications (Read more)

• What are modern data platforms, and how can they boost Healthcare agility? (Read more)

• Evolving Zoom IQ, our smart companion, with new features and a collaboration with OpenAI (Read more)

• Inside Microsoft’s sprint to integrate OpenAI’s GPT-4 into its ‘365’ app suite (Read more)

• PaLM API & MakerSuite: an approachable way to start prototyping and building generative AI applications (Read more)

• A demonstration of interpretability for Reinforcement Learning from Human Feedback (RLHF) models (Read more)

• Ready-to-use models and support for custom text and image classification models in Amazon SageMaker Canvas (Read more)

DEAL FLOW

• Mark Cuban Cost Plus drug company collaborates with Zócalo Health to lower prescription drugs costs for the Latino community (Read more)

• Clearday to combine with Viveon Health SPAC (Read more)

• Medtronic, DaVita launch Mozarc Medical, an independent new company committed to reshaping kidney health and driving patient-centered technology solutions. (Read more)

• Philips and Northwell Health partner to standardize and future-proof patient monitoring across the enterprise (Read more)

• Fairview, Sanford delay merger again, pushing the deal to late summer at the earliest (Read more)

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