AI to break down barriers to health benefits in 2019

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2019 is the year that the health benefits market get smart.

Over the next few years, advanced computing technologies, such as artificial intelligence and machine learning, will take the market by storm, moving from vision to full execution. Put simply, the race is on to see who will lead the charge to take the guesswork out of healthcare funding decisions.

AI will guide employees to make smart healthcare decisions and give them the tools necessary to shop for the best price. But, the benefits of AI won’t be limited to the worker – every stakeholder in the health benefits market will capitalize on its value.

The market is ripe for disruption

Yes, it is a common cliché, but it’s also critically important to discuss. As financial responsibility for healthcare continues to grow, employees will no longer tolerate poor experiences that are overly complicated and offer limited guidance and support.

Today, most workers are left alone to choose their healthcare accounts without fully understanding the value of their options. While some employees have the benefit of an adviser to help make these decisions, in today’s digital world, this is an expensive and slow business model.

As we have seen with the recent CVS Health and Aetna merger, the industry will continue to consolidate with retail brands entering the market and merging business models between care delivery, insurance and funding with the ultimate goal to make shopping for healthcare as easy as it is for any other retail purchase.

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A Siemens AG Axiom Sireskop SD x-ray machine sits in an exam room at Perry Memorial Hospital in Princeton, Illinois, U.S., on Friday, Sept. 1, 2017. Almost eight months after PresidentDonald Trumptook office and promised to immediately repeal Obamacare, Republican senators are instead developing a small package of changes to help the health law rather than end it. Photographer: Daniel Acker/Bloomberg

With AI at the center of this convergence, a consolidated healthcare market will leverage technology to support the entire benefits lifecycle and deliver the same experience that employees have come to expect in their everyday lives, such as using a mobile app with omnichannel support to shop for health and wellness solutions the moment they are needed.

There are four common use cases where AI can immediately impact the benefits lifecycle as we know it today.

Smart enrollment decisions. It is no secret that general health insurance and financial fluency is still low. AI can positively shift perceptions of consumer-driven health plans and accounts by guiding employees to select the right combination of plan and accounts, educating them on the value and helping them to determine their personalized contribution strategy – all in an automated way that is also cost-effective for the employer and the benefits administrator.

For example, given the triple tax advantage of a health savings account, any employee that anticipates medical expenses in retirement will benefit by prioritizing and maximizing contributions to an HSA before their 401(k). AI can be used to guide employees to understand the savings value and then help them optimally fund both accounts. With a truly smart HSA, there should be an easy way to do so without requiring the employees to log into a separate account.

Smart spending guidance. Employees can also use AI to open their benefits’ app to find a provider, price and quality-of-care combination that meets their immediate healthcare needs. Imagine the day, which is not too far away, where workers use their smartphone to find the closest retail pharmacy that offers a free strep test while the urgent care three miles away charges $75.

Smart saving for the future. Employees are not disciplined about saving in general, so it’s a stretch to think they will aggressively save for their healthcare without a lot of explanation. With smart health benefits, AI will track and analyze consumer healthcare spending to provide personalized recommendations that maximize ever dollar while preparing the workers to better save for the future.

Smart incentives. Incentives will continue to have their rightful place in the benefits lifecycle. Applying AI to maximize their value, incentives will become even more personalized to help workers better manage and prevent the onset of chronic disease. Employers will be able to set, track, and personalize goals around diet, exercise, and even sleep – often using benefit account contributions as a financial reward.

The health benefits market is at an inflection point and to get to the end goal, AI, alongside a superior technology stack, market share, access to capital and speed to market, will determine the future leaders. This year, will be an exciting year for healthcare, and benefits professionals should be prepared for some major transformations.

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