McKinsey April 8, 2021
Zahy Abou-Atme, Shubham Banerjee, Jessica Lamb, and George Stein

Using AI on claims and other data sets can help identify those potentially needing care.

Payers and providers both have a mission to keep members and patients healthy, but, too often, individuals end up in the emergency department (ED) due to avoidable exacerbations of care or because they are unaware of other options for their ailments. It is estimated that approximately a third of ED visits may be preventable, indicating factors that may include poor care management or challenges with healthcare access. Payers can utilize artificial intelligence on claims and other data sets to proactively identify those potentially needing care, before conditions deteriorate. Translating insight to action requires collaboration across analytics,...

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Topics: AI (Artificial Intelligence), Insurance, Payer, Provider, Technology
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