How 7 payers are using AI

Payers are using artificial intelligence to speed up administrative processes, improve customer services and analyze data. 

Here are seven ways payers are implementing the technology: 

  1. Health Care Service Corporation, which operates Blue Cross Blue Shield affiliates in Illinois, Texas, Oklahoma, Montana and New Mexico, is expanding AI technology to speed up prior authorization. The company said it expanded the use of its AI technology, which can make the prior authorization process up to 1,400 times faster, to inpatient acute care and other areas.

  2. Oscar Health published a glimpse into how the payer uses AI. The company published its research on large-language AI models and several potential use cases in the healthcare industry. 

  1. Centene CEO Sarah London said technology and artificial intelligence could bring positive changes to the healthcare industry in the coming years. "There's a great opportunity to bring down the administrative cost structure of healthcare in a major way over the next decade," Ms. London said.

  2. An AI-powered model improved maternal health outcomes for Molina Healthcare members. The model, used with over 150,000 patients over 18 months, led to a 60 percent decrease in racial disparities in preterm births among Black women. 

  1. Elevance Health offers artificial intelligence-powered digital concierge care to just under 5,000 members today in an effort to provide meaningful, personalized care for members with chronic conditions such as diabetes, Crohn's disease and long COVID-19.

  2. Blue Shield of California uses Google Cloud technologies to streamline its prior authorization process and help deliver timely clinical care for 4.8 million members. 

  1. Blue Cross Blue Shield of Massachusetts is using artificial intelligence to detect more fraudulent claims, an issue that costs the healthcare system billions of dollars every year and raises costs on health plan members.  

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