Solution for Insurance: Care management journey.

AI will be a BIG win for the insurance industry. ⚡️ But why should you care?

Care management journey. Care management involves numerous data sources that are often integrated into disparate, unconnected systems. Here, (Gen)AI can showcase its far-reaching potential by structuring, integrating, and analyzing various data sources to drive personalization of both the customer and patient experience across all treatment areas. Notably, AI-driven predictive analytics can more accurately and efficiently identify at-risk patients, thereby enabling highly personalized care management with early preventive health care that ultimately increases overall patient well-being and health. For example, a German health insurer implemented an AI model co-developed with BCG to predict the risk of hospitalization for heart failure in the next 12 months out of all hypertension patients with a known risk factor. By proactively addressing at-risk members to see a general practitioner or cardiologist, up to 20% reduced hospitalizations in heart failure were realized.

Additionally, (Gen)AI enables patient-specific selection of appropriate and available providers—including appointment management through predictive algorithms that factor in real-time data on cancellations and emergencies. These applications highlight the need for a clear vision and strategy of (Gen)AI implementation to realize incremental potential from combining traditional AI and GenAI.

Author

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