Leveraging AI and Machine Learning for Enhanced Preventive Care and Chronic Disease Management in Health Insurance Plans

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Ramanakar Reddy Danda,Valiki Dileep,

Abstract

COVID-19 has thrown a spotlight on the importance of improving prevention and long-term disease management. Despite substantial effort, preventive healthcare compliance remains suboptimal for a variety of reasons: financial, geographical, situational, awareness, or due to primary care physician access constraints. Health insurance companies can play a leading role in enhancing preventive healthcare by incentivizing members and shifting focus towards value-based care. By leveraging modern AI and machine learning, insurance companies can harness the vast amounts of digital health information that flows into their ecosystems to better understand the evolving health risk profile of their members. The resulting insights enable the companies to properly identify and engage such members promptly, with a focus on improving overall health outcomes and thereby reducing long-term cost burdens. To enhance risk prediction and patient outcomes further, companies can increasingly tap into digital mechanisms to deliver a variety of existing and innovative interventions. The outcomes achieved from the interventions can then be looped back into the health risk prediction models to enhance and refine the risk prediction capabilities continually. Finally, due care should be exercised at all times to sensitively and responsibly manage the digital health information generated at such a scale. As digital health information volumes scale up exponentially, both in breadth and depth of member-relevant health data, AI and machine learning can be deployed in concert with various modalities of health intervention for preventive care and long-term health management. With the right kind of oversight and responsible stewardship of patient data, these new insights can be acted upon effectively to improve overall health outcomes while creating a health environment that members are more than willing to engage with. With advances in both predictive modeling and intervention therapy arms, AI and machine learning have the potential to deliver significant improvements in health outcomes and decrease cost burdens associated with chronic health conditions, especially within the health insurance domain.

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