Unraveling the Challenges and Opportunities in 2025 Healthcare
Half of the Top 10 US Health Insurers and AI
In 2025, an astonishing half of the top 10 US health insurers are set to utilize AI to enhance member advocacy. Health insurers had previously invested substantial amounts in digital experiences with the aim of promoting member self-service. However, they faced lower than anticipated digital adoption rates and mediocre customer ratings. Call volumes to health insurers continue to rise significantly. Now, the prolonged period of poor customer experience has drawn the attention of the US government. In this year, US health insurers will embrace the human element to bring down costs and strengthen the wavering trust of members. They will invest in generative AI-powered tools to assist contact center employees and care advocates in building stronger relationships with members.AI's role in bolstering member advocacy is crucial. It enables insurers to provide more personalized and efficient services, addressing the concerns of members more effectively. This shift towards AI utilization is a response to the changing landscape and the need to improve customer experiences.
By leveraging AI, health insurers can streamline processes, reduce administrative burdens, and enhance communication with members. This not only leads to improved customer satisfaction but also helps in managing rising costs within the healthcare system.
One-third of Leading Health Insurers and Prior Authorizations
In recent years, payers have employed AI algorithms to expedite and reduce the cost of processing prior authorizations (PAs). But this usage has transformed into overuse, resulting in increased administrative burdens for providers and care delays. The PA-fueled bureaucracy and payment delays have led some health systems to withdraw from payers' networks during a plan year, accelerating the spread of medical deserts.From national legislation to state-specific laws, payers are now reevaluating their PA processes. They are carefully assessing the risks and balancing the cost of removing PA requirements with its potential benefits. This shift indicates a growing awareness of the need to streamline processes and improve the efficiency of healthcare delivery.
By decreasing reliance on PAs, health insurers can reduce administrative complexities and enhance the speed of care delivery. This, in turn, can lead to better patient outcomes and increased satisfaction among both providers and patients.
Three More States and Hospital Cybersecurity Requirements
Cybersecurity attacks, such as the one on Change Healthcare, have left a trail of destruction. The newly proposed Health Infrastructure Security and Accountability Act aims to make healthcare cybersecurity controls mandatory and enforceable. However, the bill still has a long legislative journey ahead, and the industry is likely to face challenges in meeting its standards.New York is taking the lead by introducing new cybersecurity program requirements that enhance security controls and mandate more stringent risk assessments and better incident response. This sets a precedent for other states. We expect Massachusetts and California to follow suit, and Illinois, Texas, Florida, and Washington may also join in due to their intensified focus on privacy and cybersecurity laws related to healthcare.
HCOs need to be well-prepared for these three more state-level initiatives that will regulate cybersecurity in 2025. By implementing robust cybersecurity measures, they can protect patient data and ensure the smooth operation of healthcare services.
Get further insights with additional complimentary resources, including e-books and webinars, on the Predictions 2025 hub.This post was written by Principal Analyst Arielle Trzcinski and it originally appeared here.