How AI is transforming insurance on the front lines of COVID-19

In his house on the western side of Seattle, Washington, 70 year-old Michael Flor continues his recovery from COVID-19. Flor was hospitalized for two months in early 2020 with the disease, and came so close to death that he said his goodbyes to his family while talking on a cell phone held to his ear by his nurse because no visitors were allowed into quarantined patients’ rooms. In May, after 62 days, Flor was discharged as the area’s longest-hospitalized coronavirus patient. But he had another shock waiting for him when he got home — a $1.1 million bill.

His intensive care unit was billed at $9,736 per day, $408,912 for ensuring a properly sealed-off quarantine room, $2,835 per-day went toward the use of a ventilator, while about a quarter of the bill counted toward drug costs — 3,000 itemized charges across a baffling 181 pages.

Flor’s story is part of an emerging trend for countless Americans amid one of the worst pandemics in history. While hundreds of thousands lose their lives, others may escape with their physical well-being but also substantial financial distress.

Among the many other irrevocable changes the coronavirus has wrought on the lives of everyone across the country, the virus has uncovered the extreme expensive disparities and impossibly intricate economics of the American health care system. As we approach the sixth month of this global pandemic, Americans affected by the disease are now confronting another battle, this time against the insurance process and health care bills.

Fortunately, a solution has emerged in revolutionary ways to aid in the fight against COVID — artificial intelligence.

AI has demonstrated a record of success when it comes to the proactive and prescriptive side of the pandemic. Algorithms can be used to rapidly diagnose COVID-19 by interpreting medical scans and even pinpoint encouraging health data in the search for a vaccine. Engineer and entrepreneur Peter Diamandis told Wired that an estimated 200 million physicians, scientists and technologists are using massive amounts of data to work on any number of solutions to aid in the fight against COVID-19.

The use of AI in health care isn’t anything new. Companies reaped nearly $2 billion in AI investments in 2019, with $635 million in investments in Q1 of 2020 alone. But as the pandemic lurches on, the use of AI when it comes to the health insurance industry, and the role that processes will play in the recovery of millions of Americans, will become increasingly visible and more vital than ever.

Related: New frontier: Artificial intelligence offers opportunities for brokers

It’s easy to see how the stability of the health insurance industry framework could collapse. Issuers are likely to face a continued influx of claims at a higher cost, as well as a decrease in insurance spending because of the widespread prioritization of COVID-19 cases over elective surgeries and other procedures. With the unemployment rate still hovering above 11 percent, American workers will continue to lose employer-issued health benefits and become uninsured altogether.

The use of AI will enter into the equation to ensure those health care operations remain in place by helping to improve efficiency, safety, and overall patient outcomes.

Streamlining patient engagement

AI is empowering hospitals and providers to better identify and engage with patients throughout their battles with coronavirus, building awareness to target potentially high-risk patients to optimize their care. After being discharged, that same sort of technology can contextually understand patients and their conditions to better direct care down the line.

AI can also target patients with precision by identifying the best channels for reaching them with up-to-date medical information. Automation is streamlining the unnecessarily complex and confusing claims process, flagging medications and procedures that would require out-of-pocket costs, and is even helping to reduce billing errors and assist in contesting claim denials.

Put AI into the mix, and you move the protracted claims process into a time-saving, user-friendly place to collect all relevant information. Instead of retracing steps over and over, the insured basically populates repetitive questions with the correct individual answers to ensure vital information is accurate and up-to-date.

Controlling spend and saving lives

These technologies also collate huge amounts of relevant data to generate significant cost-saving opportunities, from applying machine learning to combined spend and contract data to ensuring that there is a better balance between patient experience and the reality of particular cases.

Even before we had a worldwide pandemic, medical errors caused more than 250,000 deaths per year. Especially in the insurance industry, most input data is prone to mistakes based on how information is stored across the industry.

But AI can work to identify, prioritize, and predict missed charges, revolutionizing the integrity of insurance claim cycles. It can also confirm and resolve missed charges that yield the highest returns at the most efficient rate while providing a comprehensive view of departments, auditor and hospital performances for greater overall transparency when it’s needed the most.

AI is poised to be a top asset in the health care industry amid COVID-19, helping providers engage more easily with patients, control spend and identify missed charges, and improve risk reduction for the insured. Such thorough data analytics will simultaneously play an immensely important role in understanding the current spread of COVID-19, and be able to understand the lasting effectiveness of our responses to disease as well.

Jim McGowan is head of product at ElectrifAI.