Amanda Barry, Chief Commercial Officer at Infermedica
The healthcare landscape continues to rapidly evolve due to advancements in technology and an ongoing shift to alternative payment models. As payers navigate this increasingly complex environment, member engagement has emerged as a critical component of successful healthcare initiatives. Now, with the advent of artificial intelligence (AI) in healthcare and value-based care, understanding and prioritizing member engagement is more important than ever.
Patient engagement has been a hot topic in healthcare for years now, but what exactly is member engagement?
At its core, member engagement refers to individuals taking an active role in their health care. In the context of value-based care, this means empowering members to decide what services they need and take an active role in advocating for their own health. And now, AI is playing an increasingly important role in supporting this engagement by providing predictive analytics, decision support, and proactive health management tools.
Issues in health insurance and the role of AI-based tools
Health systems face numerous challenges as they navigate the transition to value-based care and population health management. One of the main concerns is maintaining financial viability in a model that prioritizes quality over quantity. Payers also need to cater to ever-changing member demographics and ensure high satisfaction while addressing changing preferences and needs. The situation is further complicated by internal system interoperability, financial incentives, social determinants of health, and complex regulatory requirements.
AI-powered tools have great potential in addressing these and other challenges facing health plans. For example, clinically validated navigation tools can provide members with personalized symptom assessments and guidance on appropriate treatment options. These tools not only empower members to make informed decisions about their health conditions and treatment options, but they can also reduce the growing administrative burden faced by payers. Additionally, AI can provide valuable insights into member activities and trends, enabling early detection and intervention to avert potential health issues.
Opportunities for Payers Leveraging AI and Care Navigation Tools
Leveraging AI and care navigation tools, payers have access to a wealth of pre-claims information about member behavior and healthcare-seeking patterns. With a proactive and comprehensive understanding of their member demographics, health plans can predict needs, tailor interventions, and optimize resource allocation. Instead of relying solely on retrospective claims data, health plans can gain real-time insights into member health and engagement.
Despite the potential benefits, health plans face several barriers when adopting AI-powered tools for member engagement. Privacy concerns and regulatory compliance are ongoing challenges that require careful tactics and strict adherence to multiple standards. Interoperability and integration with existing tools can also be technical hurdles as payers strive to create seamless and efficient ecosystems. Diversity in member demographics, including differences in digital literacy and access, must also be considered. Finally, ensuring cost-effectiveness and profitability remains a top concern for payers.
To overcome these barriers, health plans must focus on addressing core business concerns while recognizing the shift toward patient-driven change. Implementing easy-to-integrate, low-tech solutions can provide a starting point for engagement without significant changes to existing systems and workflows. Highlighting the many benefits of healthier, happier, and lower-cost members can build buy-in and support for AI-powered initiatives. Payers must prioritize open communication and education to help members understand and embrace these tools.
Member Engagement, AI Adoption, and Value-Based Care Trends
As the healthcare industry continues to evolve, several trends are emerging that will shape the future of member engagement, AI adoption, and value-based care. The rise in self-funded plans and unique payment models reflects a growing desire for more personalized and flexible healthcare options. Preventive care and provider collaboration are also gaining attention as payers recognize the importance of proactive care and integrated services. Virtual care, remote care, and AI-powered virtual assistants are all becoming increasingly commonplace, providing convenient and accessible support to members wherever they are. Personalization has emerged as a key element in maintaining member engagement as individuals seek tailored experiences and recommendations.
Member engagement will play a critical role in the future of healthcare, especially in the context of AI and value-based care. As payers navigate this transformative landscape, it will be essential that they adopt tools and strategies that prioritize member engagement and empowerment.
By harnessing the potential of AI and adapting to the demands of value-based care, payers will be better positioned to succeed in an increasingly competitive and dynamic industry. Moving forward will require a commitment to innovation, collaboration, and an unwavering focus on the needs and preferences of healthcare consumers.
About Amanda L. Berry
Amanda L. Bury is Chief Commercial Officer at Infermedica, an AI-powered healthcare platform that helps healthcare providers deliver efficient, safe and reliable care to patients. Ms. Bury has over 15 years of experience connecting health systems and payers with cutting edge technology. Most recently, she served as Vice President of Global Strategic Alliances at TeraRecon, a leading provider of medical image visualization, AI development and interoperability technology. Prior to that, she served as Senior Director of Channel Development and Strategy at Kyruus for nearly three years. Ms. Bury is also a leading presence in the healthcare technology community, speaking at various industry conferences and events including SHSMD, HCIC and HIMSS.
