AI is changing healthcare – and insurers are taking notice

By GovInsider

Artificial intelligence can speed up claims assessments, sift through great amounts of data, and shake up established ways of working.

Consider what healthcare systems are faced with today: People are living longer, but having fewer children. Many countries are ill-equipped to support and care for a growing number of elderly citizens.

The prevalence of chronic diseases brings an added layer of complexity into the mix - and healthcare insurers are racing to adapt, notes Arvind Mathur, Chief Information Technology Officer of Prudential Singapore.

“Traditionally, insurance has been defined in certain ways, with very specific kinds of products and capabilities,” he tells GovInsider. “But as the needs are changing and as our consumers are evolving, those products and solutions are no longer sufficient.”

The shift from acute to preventive care is one key component to this, Mathur believes, and “insurance needs to play a greater role in making that shift happen”. There lie many opportunities in harnessing artificial intelligence and machine learning as enablers, he says.

The intersection of health and technology

First, let’s look at how AI is already shaping health outcomes today. It holds the potential to predict the rate of readmissions; reduce the impact of human error; predict hotspots for infectious diseases; and assist surgeons, according to AI expert Eric Horvitz.

“AI-based applications could improve health outcomes and the quality of life for millions of people in the coming years,” Horvitz wrote in a 2017 report as part of his ‘One Hundred Year Study on Artificial Intelligence’ initiative.

How could this look in practice? AI algorithms coupled with computer vision can be a powerful tool for radiologists, for example. While radiologists go through “decades of training” to tell whether a shadow is a malignant tumour or not, an algorithm can be trained to do that job faster.

Radiologists can then “see what the system flags and perform a visual check afterwards”, says Joel Tito, Programme Manager for AI and the Future of Government at the Centre for Public Impact.

In Singapore, AI and other technologies can “play a very big part” in changing how this knowledge- and labour-intensive industry currently operates, says Bruce Liang, CEO of Singapore’s technology agency for healthcare IHiS.

The country wants to use AI as part of a national diabetes project to identify people at risk of the disease, and get them in on early intervention programmes, he tells GovInsider. Naturally, early intervention will lead to earlier disease management, and reduce strain on healthcare resources further down the line.

Automation in healthcare insurance

AI is also fast changing the way healthcare insurance works. For instance, as the population ages and contends with long-term disease treatments, insurers will need to develop ways to approve claims more efficiently, says Prudential’s Mathur. As it is, the largely manual process can take anywhere from weeks to months.

“It's a very, very complex decision tree,” he explains. “If you ask someone to list all the rules, it's humanly impossible, and it gets more and more complicated with new kinds of diagnoses and treatments coming out all the time.”

Prudential Singapore is trialling a machine learning-based solution to effectively automate claim approvals. The algorithm will be able to assess the validity of claims and recommend decisions and payment amounts in a matter of seconds.

Quicker queries

The intent here is to create an e-claims process that requires “the least amount of effort”. “When a customer has a claim, the last thing on their mind needs to be, ‘Have I filled all the forms?’ And then wait for weeks and months to get paid,” Mathur points out.

With e-claims, they will simply need to take photos of their hospital bill, and moments later, receive an alert that the claim has been approved and credited into their account, he says.

The e-claims solution brings value in various ways: it also frees people up to focus on more meaningful, valuable work.

“The reality is that currently we are not doing enough to serve our customers because we are stuck in doing all of this routine stuff,” Mathur says.

Looking ahead, the solutions to the healthcare challenges of the future may not be as clear-cut as we would like. They will require careful planning and collaboration across governments, private sector and citizens.

What is clear, however, is the importance of three factors: a culture of innovation; an emphasis on collaboration; and a helping hand from technology.

This article was produced in partnership with Prudential Singapore.