Keeping health care personal in a tech-centric world

It’s no surprise that technology has contributed to major shifts in all aspects of health care over the past year, from patients embracing telehealth visits to the very delivery system of COVID vaccines and prescription medicines. And now, most everyone is interfacing more with emails, texts and Zoom meetings than with people. How can we retain a personal touch in health care while still leveraging advanced technology? By embracing both emotional intelligence and artificial intelligence (AI).

Related: A digital health ecosystem for COVID-19 and beyond

I believe that much of our health care system has become so automated that everything – and everyone — is a number. As leaders in the health care industry, we have the opportunity to change that. Now, some might read “AI” and immediately feel it’s counterintuitive to having a “personal touch,” but it’s actually the opposite. When we come from an empathetic perspective, we can use AI to personalize and infuse tech with “emotional intelligence.”

Here are considerations for incorporating the personal into a world of tech for employees, employers, providers and brokers:

1. Surprise and delight

You can be a technology company first and foremost, but that tech must serve the member and provide answers with personal insight. We must always be asking, “how can we eliminate stress for our members,” “how can we help them quickly navigate to the right answers?” It’s essential to remember that today most people don’t turn to their health plan unless they’re not feeling well or have a dependent who is ill. This typically means they’re already coming from a place of stress. When my child is sick, I want to get a fast and effective response, and not spend time navigating a complicated IVR phone system. In our high-tech world, we all still want to have a human point of contact. Aim for a partner that is efficient but well-staffed with people, too!

Creating ease and simplicity is often a pleasant surprise for patients who are used to impersonal or frustrating experiences. By the way, that delightful experience also helps drive loyalty and invaluable word of mouth.

2. Health care, like politics, is local and personal

There are optimal ways to leverage the latest tech to create cost efficiencies while still remaining member-centric. Look for health plan tools that include local market information about providers and regional services. Geographic zoning adds a comfort zone for members. Make sure information, like in-network area providers and their quality metrics, is readily available to members. This helps minimize research time and offers another way to personalize and individualize care.

Incorporating marketplace or regional trends via the help of AI adds insights to that local information in a proactive and cost-efficient way. For example, when I see diagnosis codes over and over again for people in certain localities, it enables me to recognize practice patterns of providers within that area.

3. The interpretative dance

Search for TPAs offering technology tools that help people predict what might be coming down the road. Though many claim to do this, it’s actually not in universal use yet, so a little homework can greatly benefit brokers and employers. Here’s why: AI can be applied to recognize prescription drug patterns or claims histories, better analyze lab work and radiology procedures; it creates an “if this, then that” scenario.

Some might see a blood test as insignificant in the grand scheme of things, but if that person has four tests in a two-month period that’s an indicator to seek a reason why. The algorithms employed by AI can spotlight something happening there. That creates the opportunity to infuse a “high touch” experience using the findings of the “high tech” system. Refer the claim to a care navigator to do member outreach. Members feel cared for. Claims are more effectively adjudicated. Costs are better managed. Tech insights fused with human intervention creates a win-win scenario for everyone.

4. High touch can still be low cost

Tech plus data efficiencies can also mean an opportunity to provide members access to best-in-class — but not necessarily the most expensive — providers. And a high-quality provider who may be able to better assess a care plan that averts a costly surgery, like a knee replacement, for example, and suggest an alternate, less costly, yet equally effective treatment through physical therapy. Being able to assess providers that meet and exceed quality metrics allows more options in recommendation packages. And that can amount to huge cost savings down the line.

The time and place for depersonalization

With personal privacy so top of mind these days, it bears mentioning that the information coming into systems must be de-identified at every possible opportunity. The aggregate of data is what helps TPAs make projections and identify demographics and population management. But it’s that same access to information that demands scrupulous responsibility.

The analysis of data can help someone become healthier and reduce their costs by being able to proactively seek proper treatment early enough to avoid large, protracted and costly claims. AI assists carriers in underwriting groups which results in lower premiums for the employer. Knowledge is powerful in the hands of plan members who take an active interest in their current and future health care needs, for them and their families. When applied well it can be for the greater good of employers and members.

Read more: 

• Pandemic driving increased consumer interest in tech-driven health care
• Technology puts health care in patient’s hands, creates community
• Health care data analytics: true meaning, actionability and value