As costs soar, could AI and virtual care save the day?

Health care benefits are expected to hit a new milestone in 2019, with costs approaching a mind-boggling $15,000 per employee according to a new report issued by the National Business Group on Health. The report also reveals that the majority of employers view the rise of artificial intelligence and telemedicine as a major player in the disruption of health care in 2019. A full 51 percent of companies have made virtual-care solutions their top initiative, while 43 percent believe that artificial intelligence will play a major role in solving the problem of escalating costs.

With costs at a new record high, companies are reaching the limit of being able to pass on these costs to their employees. Cost-sharing techniques have resulted in employees bearing 30 percent, a total of $4,500 a year, making health care nearly unaffordable for many. Rates have averaged an increase of over 5 percent annually for the last five years. Companies are demanding solutions and are turning to technology to save the day.

“Seven in 10 employers believe new market entrants from outside the health care industry are needed to disrupt health care in a positive way,” says Brian Marcotte, CEO of National Business Group on Health. “Disruptors include innovators from Silicon Valley and elsewhere.”

Virtual care solutions like telemedicine have become more commonplace as a part of a standard benefits package over the last 10 years. While many of these early services showed promise, their biggest Achilles’ heel has always been utilization. When they first launched, they depended on paper benefit packages and call centers to spread the word. These services launched five years before the iPhone, so they had to depend on analog techniques for usage. Over the last couple of years, newer, smartphone-centric telemedicine solutions have come to market, bringing a Silicon Valley approach to telemedicine. And utilization has skyrocketed.

“The providers that have been in the market for a while are only providing a single point solution and haven’t been able to overcome their utilization issues,” says Rick Fielding from Salt Lake City-based GBS Benefits. “Newer telemedicine providers are tackling the whole health care experience and include a whole range of services in a single app that becomes the first stop an employee turns to when they need to deal with health care. These new providers are a game-changer.”

Usage of artificial intelligence has become more prevalent in employee benefits in 2018, and the trend is expected to accelerate in 2019. TPAs have started to turn to artificial-intelligence-powered virtual assistance as a better way to service their customers. One TPA that’s leading the way is Cypress Benefit Administrators, which recently launched an artificial intelligence pilot project. “A more engaged employee will lead to more informed decisions about care, and this will maximize quality and cost-effectiveness,” says Tom Doney, president and CEO of Cypress. “We’re hearing our clients’ requests for health plan information that is less confusing and more accessible, and our solution is designed to address both.”

Companies are also using artificial intelligence to enhance benefits programs. Servicing members is expensive, and technologies like AI-powered virtual assistance lower costs while increasing proactive outreach. As claims data is integrated into these platforms, more targeted and personalized outreach is possible. This will lead to greater health care savings, which may finally begin tackling the annual increase in premiums.

We are seemingly on the cusp of a revolution in AI-driven health care services. Nature.com recently reported on a breakthrough from Google’s DeepMind that can detect over 50 sight-threatening eye conditions using AI with the same accuracy as an expert clinician. These services can be performed by using pennies in computer-processing power rather than a doctor, and have the ability to drastically change medical pricing. There will always be a place for human doctors in health care, but AI will have a huge impact in fields where detecting patterns is part of the diagnosis.

Next year is shaping up to be the year of artificial intelligence in health care. To maintain competitiveness, companies need to start incorporating tools and services that use these advanced technologies now. Employee benefits is the second largest expense operating expense for employers, so using technology to lower costs is vital to keeping Americans competitive in the world marketplace.

Rick Ramos is CMO for HealthJoy.com, a healthcare guidance and engagement platform that empowers employees to make better decisions.