20 Ways AI Could Assist Medicare Advantage Plans

We are living in an exciting time in the Medicare Advantage sector. The combination of regulatory changes and AI is opening up opportunities to improve member experience and operations and improve reporting. Operational excellence can be redefined and accelerated by replacing time- and resource-intensive things with AI solutions. The human capital that currently uses spreadsheets and spends hours on analysis can use its expertise to design new processes and solutions to manage the regulatory tailwinds driving change.??

I have put together a list of areas where I see plans could use help to better serve their members:

1. Technology to provide third-party assessments of supplemental benefits: Develop a standard by which a startup can confirm that their service provides a tangible benefit to members.
2. Predictive analytics software to accelerate and simplify the bid process and run scenarios for health plans to dig deeper than is currently happening into what benefits are being used and why.
3. Technology to support customer service and better route calls to either internal or external call centers, brokers, or clinicians with the appropriate skill set to address specific challenges.?
4. Predictive analytics solutions to anticipate changes in healthcare utilization patterns: This is particularly relevant post-COVID-19, as patterns of care have shifted.?
5. Tailoring care management programs and patient care plans for at-risk individuals, SNPs, and chronic condition populations using machine learning.
6. Telehealth services which are accessible to all people regardless of language preference, disability, or technology skills.?
7. Tools that use AI to simulate the impact of regulatory changes and adapt to evolving Star rating criteria. Tools that help track and improve performance across various measures can be invaluable to MA insurers striving to maintain or improve their ratings.
8. Utilizing data analytics, startups can help MA insurers better understand and predict evolving member needs and preferences for targeted product development.?
9. Digital platforms and AI chatbots for efficient and personalized member engagement to redefine how insurers interact with their members.
10. Big data analytics can identify growth opportunities within SNPs.?
11. Startups can deploy AI to map social determinants of health and identify at-risk individuals.?
12. Digital platforms to facilitate care coordination and integrate services?
13. AI-driven cybersecurity solutions and blockchain technology to secure patient data and ensure regulatory compliance.
14. Technology to identify distribution partners that are underperforming or not adhering to regulations.?
15. Improved vendor management software to ensure all vendors use consistent messaging and communication with members.?
16. AI-driven systems are needed to improve the seemingly intractable problem of timeliness,? accuracy, and synchronization of provider directories.?
17. An improved system is required to support communication in all the languages a health plan must support.?
18. Technology to assess compliance with marketing and communication materials that adjust when new regulations are uploaded into the system.?
19. Improved eligibility and enrollment tools for Medicaid, SNP plans, and subsidies.
20. A system similar to Zapier for health plans to more easily create workflows for healthcare without massive implementations.

It is possible companies are working to solve each of these areas already, but across the board, we are seeing that these are areas that, with the changing regulations and AI could be enhanced and result in improved outcomes for members and greater operational efficiency.