BPJS Kesehatan to use AI to improve efficiency, healthcare services 

Indonesia’s BPJS Kesehatan (the country’s social security agency for healthcare) aims to improve efficiency, accelerate data analysis processes, and prevent potential fraud in the implementation of the national health insurance (JKN) programme, by using artificial intelligence (AI) tools, according to BPJS Kesehatan's Assistant Deputy for Data and Information Management, Rahmat Hidayat. 

Speaking at the launch event of BPJS Kesehatan’s Healthkathon 2024 in Jakarta, on July 10, Rahmat said BPJS Kesehatan’s decision is in line with global trends where organisations around the world are accelerating the use of AI technology for better outcomes, as reported by Freshfields Bruckhaus Deringer.  

"AI is seen as the most urgent need (for organisations) to improve efficiency and business processes," Rahmat said.  

BPJS Kesehatan manages a lot of data and AI is  needed to analyse this data, he said. Since the JKN programme started in 2014, BPJS Kesehatan has collected more than 442 billion data sets, comprising, among others, membership data, health service data, and participant contribution data.  

AI also can help detect potential fraud in the financial transactions of the organisation and service partners. Fraud and cyber-attacks are now more sophisticated, for example fraudulent claims, and we need technology to overcome them, Rahmat added. 

Currently, the BPJS Kesehatan system has been integrated with more than 960,000 digital payment channels, 27,000 health facilities, comprising 3,000 hospitals, 22,000 community health centres or family doctors, and two thousand pharmacies across Indonesia. 

Three focus areas of AI 

Rahmat explained that BPJS Kesehatan focuses the use of AI in three areas: user experience, process improvement, and insights and prediction.  

BPJS Kesehatan is integrating natural language processing (NLP) capabilities within chatbots and recommender systems from machine learning (ML) to provide new experiences for users in accessing health services.  

AI technology embedded in the Mobile JKN platform will make it easier for patients to manage the registration process and schedule visits to health facilities. Patients can use the online queue system to avoid waiting at the hospital for too long, he said. 

“Sentiment analysis on NLP also allows JKN participants to get health news that matches their interests or disease history," Rahmat continued.  

Next, BPJS Kesehatan is developing robotic automation technology to accelerate transformation and process flow in service delivery. It is expected that repetitive work processes can be automated by machines, to reduce the potential for errors in work. 

Predicting patient behaviour 

BPJS Kesehatan has also developed predictive and forecasting analytics, as well as several other algorithms to detect and predict patterns, trends, and clustering of diseases to provide appropriate treatment to JKN users. 

Other models that have been developed, include analysing the referral patterns of participants at first-level healthcare facilities, predicting the level of susceptibility of a person to diabetes or hypertension, predicting the number of visits and treatment costs, and detecting anomalies in health claims. 

In developing these models, BPJS Kesehatan relied on the organisation's internal team of data scientists. However, BPJS Kesehatan does not rule out the possibility of collaborating with third partiy vendors in future.

"Collaboration with third parties aims to obtain technology transfer and improve employee competence in developing BPJS Kesehatan's digital services," Rahmat said. 

GovInsider has previously reported on how AI is driving healthcare transformation in Indonesia, providing analytics to determine health interventions, and facilitating monitoring processes when outbreaks occur. 

BPJS Kesehatan launches Healthkathon 2024

BPJS Kesehatan has launched "Healthkathon 2024" as an annual event that will provide a platform for learning, exploration, and collaboration in supporting the national health insurance technology ecosystem.  

BPJS Kesehatan’s Director of Information Technology, Edwin Ariestiawan, said in his opening keynote at the event that digital technology plays an important role in transforming health services. "Through this competition, we hope to find new innovations that can help BPJS Kesehatan provide better services to the community." 

According to Edwin, there were three competition categories in Healthkaton 2024. The categories were cyber security, AI, and innovation system. In the cyber security category, participants will conduct penetration tests to find system vulnerabilities that could be exploited by cybercriminals.  

In the AI category, participants were tasked to  develop generative AI (GenAI) based technology in the health sector. The next category was innovation system which assesses and hels in the development of innovation systems on mobile or web applications in supporting the quality of services for JKN participants. 

He said Healthkathon 2024 would produce fresh ideas and new breakthroughs to maintain the sustainability of the programme, anticipate frauds, errors, and discrepancies that have the potential to reduce the quality of BPJS Kesehatan services. 

This article was originally published in Bahasa Indonesia.