Comment & Analysis

The future is now: the role of AI in healthcare insurance

Insurance is a wide-ranging, all-encompassing industry that is experiencing transformation through technology. Known as ‘insurtech’, new solutions are enabling players to streamline operations or provide services that are more tailor-made to customers. 

Healthcare insurance is a subsection within the wider industry and the global market is forecast to be worth $2021 billion by 2027. Organisations in the sector help patients to get medical assistance and the current pandemic has placed the industry in the spotlight, with the acceleration of digital tools throughout healthcare altering expectations. Patients now expect digitisation throughout all touchpoints, starting from health insurance right through to healthcare delivery. 

As such, it’s time for healthcare insurers to adopt new technologies, such as AI, across all processes. Not simply to streamline admin and claims processing, but to improve symptom checking and triage processes too. 

How traditional healthcare insurance processes can create unnecessary expenditure 

Typically, when a patient rings up their insurer with their symptoms and to understand what options are available to them, the operator isn’t always a healthcare expert. They may instead get referred to a specialist who can better understand their issue or operators may rely on systems based on static decision trees to work out the next steps. 

Static decision trees work as a flowchart, with the user guided down specific routes depending on the answer before, leading to a final ‘decision’. In healthcare’s case, this results in the operator triaging the patient – assigning a degree of urgency to the issue – with instructions potentially ranging from performing self-care to calling for an ambulance immediately. 

Yet, the challenge with such systems is that operators are forced down a specific route with a certain set of questions, and there’s little consideration of other outside factors. This becomes incredibly challenging for symptoms that have a wide range of potential causes. 

Chest pain, for instance, can mean completely different things in young adults and the elderly, and there are so many other factors that can cause such a symptom too. With such a huge variety of possibilities, and without much needed additional questions and context, decisions driven by rule-based systems will usually be too conservative. Consequently, many patients are triaged to a higher urgency than is actually required. 

Now, this is of course the safest option. But when patients turn up at their local doctors’ surgery or A&E with issues that don’t really require medical assistance, it results in unnecessary expenditure for all involved and impacts how long doctors have to spend on patients with more serious issues.

How AI can enhance the experience for insurer and patients 

The introduction of AI to symptom checking has the ability to transform the process for all involved and some insurers – such as Allianz – have already taken the step. 

For insurers, the evolution of static decision trees to AI solutions means operators can provide patients with accurate advice that is more closely in line with what they would receive from a doctor. Solutions learn and grow and are backed by huge quantities of data relating to thousands of symptoms, conditions, risk factors and lab tests. These data sets are forever being bolstered and verified by real-life medical specialists, with further information only taken from proven, reliable sources such as medical journals and specialist agency (such as WHO) guidance. As such, insurers have the assurance that the advice being provided to patients is rooted in fact. 

Additionally, more advanced AI which can consider everything, such as detailed histories, current situation, or place of residence, will enable insurers to offer packages that are more closely tied to the user’s real-life risk. This means premiums can be specific to individuals, making them more attractive packages then general coverage options. 

From the patient’s perspective, AI solutions can provide far more accurate health advice than ‘Dr. Google’. Many of us have been guilty of using the internet to try and work out what a symptom may mean, but results are based on SEO and algorithms – not the actual patient’s real-time condition. In fact, a study into 36 mobile and web-based symptom checkers found they only produce the correct diagnosis as the first result just 36% of the time. If patients have quicker access to more accurate advice through their insurers, it can save them a whole lot of worry.

The benefits stretch to doctors too 

Now let’s consider things from the healthcare provider’s point of view. AI that can effectively triage patients – i.e. direct them to the correct level of care required – can help doctors by enabling them to understand the seriousness of an issue before they have even laid eyes on a patient. They will understand how swiftly they need to act and how best they can prioritise cases without potentially endangering lives. They will also be provided with a patient’s full history and risk factors, meaning they don’t have to ask those questions themselves – saving even more time. 

In the future, AI will get to a point where it can provide medical instructions, such as prescribing common drugs and directing patients to the pharmacy – alleviating even more pressure on GP surgeries and A&Es.  

Embracing change in healthcare insurance 

The insurance industry is one that has undergone huge change in recent years with new technologies and innovation evolving how services are delivered. It’s an industry that thrives on unpredictability, but one thing is for certain for healthcare insurers – it’s time to consider how AI can be adopted to improve services. 

The introduction of the technology has the ability to transform processes, enabling insurers to offer patients faster, more accurate advice that ensures they get the right level of care required. Embracing innovation such as AI has so many benefits for all involved and, moving forward, it’s vital that the boundaries of technology continue to be pushed. 


By Piotr Orzechowski, CEO at Infermedica 

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