3 Ways That Payers Leveraged Artificial Intelligence in 2020

Advancing value-based care

The coronavirus pandemic reinforced some of the major benefits of value-based care agreements. As fee-for-service reimbursement opportunities plummeted, providers began to recognize the value in consistent, capitated payment models such as global payments.

Now, payers are looking for ways to build on that momentum and enhance their value-based care strategies. Some are turning to artificial intelligence.

In its recently finalized acquisition of Apixio, Centene aimed to leverage artificial intelligence to broaden the evidence base that the payer uses for value-based reimbursement.

“Apixio's technology will complement existing data analytics products including Interpreta, creating a differentiated platform to broaden support for value-based healthcare payment and delivery with actionable intelligence,” Michael F. Neidorff, chairman, president, and chief executive officer of Centene, said in a statement prior to the acquisition’s finalization.

The vendor will provide Centene with an artificial intelligence platform that can both find and examine unstructured patient data. Upon organizing this data, the platform can present payers and providers with quality measures information and feedback on services for value-based care reimbursement.

“Centene is committed to accelerating innovation, modernization and digitization across the enterprise and solidify its position as a technology company focused on healthcare,” Neidorff added. “Apixio’s capabilities are closely aligned with our plans to digitize the administration of healthcare and to leverage comprehensive data to help improve the lives of our members.”

Personalizing, streamlining member engagement

Payers continued to see low member satisfaction with member engagement strategies in 2020, a JD Power survey discovered. Experts recommended that payers partner with members to help them navigate the healthcare system and lower their costs.

When Anthem Blue Cross announced its new health plan, an exclusive provider organization, the payer chose to support members’ navigation and member engagement through an artificial intelligence application called Blue Connection.

The app aimed to connect members with a provider that they might relate to on a personal level. In their profiles, providers might share not only about their professional specialties, but also about their personal interests and practice philosophies.

“By going through the process of reading those profiles, you will engage more readily with your primary care physician,” Beth Andersen, president of Anthem Blue Cross, told HealthPayerIntelligence, referencing the intended member experience. “You won't bypass him or her to go directly to specialists. You will form a relationship.”

The app also incorporated easy appointment scheduling with a “Schedule Now” button. By streamlining the scheduling process, plans might reinforce the member’s relationship with his primary care provider. Keeping this relationship central has proven critical to managing healthcare spending.

In addition to boosting member engagement strategies, Anthem Blue Cross also indicated that it would use the data from its artificial intelligence app to support its value-based care models. Certain metrics in the app—such as high-value referrals and appointment scheduling through the app—could lead to upside payments for providers.

Supporting medication adherence

A variety of organizational, personal, and societal factors may prevent members from adhering to their medication and treatment plans. At times, healthcare providers do not offer patients enough information to access their medication or patients lack the healthcare literacy to identify the information that they need in order to access or refill their prescriptions.

Anthem Blue Cross Blue Shield in Ohio (Anthem) further developed their Anthem Skill, a voice-activated assistant available through Alexa, to make it easier for members to access prescription information.

“Expectations have evolved and people want secure and easy-to-use access to their health information across multiple devices including phones, tablets, computers and virtual assistants. Enhancing the Anthem skill for Alexa is just the latest step in our digital-first approach to healthcare,” said Steve Martenet, president of Anthem Blue Cross and Blue Shield in Ohio.

With the new improvements to the Anthem Skill, members can receive information about prescription refills and renewals. The artificial intelligence assistant can also support members looking for updates about their prescription orders.

Like the Blue Connection app, the Anthem Skill can support positive member engagement. Members can ask Alexa questions about their current Anthem health plan at any time of the day or night and receive a response from the Anthem Skill.

“The company will continue to further enhance the Anthem Skill through consumer feedback to determine what types of information individuals would find useful in navigating their healthcare,” the payer stated in the press release.

The new year will test whether these artificial intelligence programs satisfy their intended purposes--enhancing value-based care strategies, improving member engagement, and increasing medication adherence--as payers pursue these and other objectives in 2021.