Preventing Missed AI Opportunities in Healthcare Payers: Key Findings from the McKinsey AI Report

Before you get into deeper about the McKinsey AI Report on embracing the AI trends in health insurance, let us learn the three key takeaways from the recent McKinsey insights on AI.

Three Key Takeaways From the Recent McKinsey AI Report on the AI Opportunities Available To The Payers

1. If payers fully implemented already available generative AI trends in health insurance, on average they could save 13-25% on administrative costs, 5-11% on medical costs, and increase revenues by 3-12%.
2. Marketing and sales, utilization management, and IT are the divisions with the largest potential opportunities for AI adoption by payers.
3. Payers that want to better use AI-driven healthcare solutions should have these six key things: a strategic plan, the right talent, a conducive operating model, technological capabilities, consumable data, and the ability to ensure adoption and scale.

McKinsey Insights on AI About The AI Integration in Payer Systems 

Payers currently face economic pressures that are likely to last a few years. Utilization of medical services has been higher than expected, providers are passing along higher costs through rate negotiations, and Medicare Advantage reimbursement rates are facing the most substantial downward pressure that payers have seen in years. In the face of these issues, the McKinsey AI Report highlights two considerations that can lead to enhancing payer efficiency with AI. 

These insights are the never-missed AI opportunities in healthcare for the payers. Without any delay, let’s quickly get into it and see how the integration between payers and AI implementation can boost the overall efficiency of the healthcare system. 

• Leveraging AI for Enhanced Efficiency and Savings in Healthcare Payer Systems

The first AI benefits for payers according to the McKinsey AI Report suggest that the opportunity is sizable allowing the healthcare payers to embrace the healthcare innovation with less competition. To be simple,  AI adoption by payers allows for improving affordability, quality, and patient experience in the healthcare industry to a great extent. For a successful AI Integration in payer systems, first, the payers need to understand the economic opportunity of each function or process in health insurance. Then you need to find the potential administrative, and medical cost savings and increased revenue for payers that adopt AI-driven healthcare solutions in their services. 

From the diagram, it is seen that integrating payers and AI implementation could increase the net savings from 13 percent to 25 percent in administrative costs and 5 percent to 11 percent in medical costs. Also, the data clearly shows a jump in revenue from 3 percent to 12 percent thereby enhancing payer efficiency with AI. McKinsey AI Report states that the calculations in the above diagram are based on an average-performing payer. The lower performers can see higher improvement suggesting that the future of AI in health insurance is sure to take the healthcare sector to great heights. 

Source: McKinsey & Company

Payers also need to know that the AI trends in health insurance can improve overall primary care and provide great opportunities in all-payer domains. Some of the powerful and stand-out domains that can outperform AI-driven healthcare solutions include claims, network and contracting, utilization management, care management, and information technology.

In short, to capture the full value of the AI opportunities, healthcare payers must reimagine the end-to-end processes of each domain. The experience of companies in other industries that are further along the journey shows there is a competitive advantage for those who can harness AI Integration in payer systems.

• Seizing the Opportunity Demands Core Rewiring

The second McKinsey insights on AI found that capturing impact is about much more than just the technology. In “Rewired: The McKinsey Guide to Outcompeting in the Age of Digital and AI (Wiley, 2023),” the authors outline the six areas that matter the most for companies across industries while integrating payers and AI implementation. These six areas include – a business-led digital road map, talent, operating model, technology, data, and adoption and scaling.

The McKinsey insights on AI further stated that the companies that successfully execute AI trends in health insurance pursue all six areas. After all, the future of AI in health insurance is more than just building an operating model or investing in the tech infrastructure. Getting the job done requires a focus on the change management challenges that arise due to the AI adoption by payers, and it’s a job for the CEO and the entire C-suite, not just the CIO or CDO.

What Does McKinsey Insights on AI Mean For The Payers?

If the payer CEO doesn’t want to miss AI opportunities in healthcare, they must quickly create AI-driven healthcare solutions. The size of the opportunity suggests that those who choose to wait will need to have a ready response plan if competitors move ahead successfully. For example, followers could find themselves in a position where industry leaders have 10 percent lower medical costs or 20 percent lower administrative costs, a daunting prospect. So the ability to be a fast follower will be critical.

In general, most payers are ill-equipped to pursue this opportunity while enhancing payer efficiency with AI. To do so, they have to close the gap that exists between their current capabilities and those needed to fully address the six areas outlined above.

Key Questions for Payer CEOs to Assess AI Integration in Payer Systems

Payer CEOs could begin assessing their respective situations by answering these questions:

1. How would we respond to a competitor with 20 percent lower administrative costs or one with 10 percent lower medical costs with the AI integration in payer systems?
2. Where are the biggest pockets of value for our business? Would that be a domain? A business unit? A function?
3. Even if we’re not ready to embrace the future of AI in health insurance today, can we “rewire” a portion of the business so that we know what to do if and when we need to move ahead? 
4. Do we have access to the talent steeped in the payers and AI implementation? Does this tech talent understand how our business works?
5. Do our leaders and managers understand how these AI trends in health insurance work, at least enough to identify opportunities and work collaboratively with our technologists?
6. Do we have the underlying technology infrastructure to allow modeling and innovation thereby enhancing payer efficiency with AI?

Conclusion

In essence, capturing the AI opportunities through AI integration in payer systems is big leadership for CEOs and their top teams shortly. For successful payers and AI implementation, CEOs will need to establish a governance and risk framework and mobilize the full organization to pursue the six areas discussed above. They can’t do this overnight, but the combination of opportunity size and the mounting pressure on the industry means it’s time to start asking themselves these tough questions.

Looking for a reliable platform that can provide medical updates in the healthcare sector? Discover the latest payers’ news updates with a single click. Follow DistilINFO HealthPlan and stay ahead with the timely payer’s news updates. Join our community today!

FAQs

1. What are some key opportunities for payers to integrate AI trends in health insurance?

Ans. Some key opportunities include significant savings in administrative and medical costs, as well as potential revenue increases ranging from 3% to 12%.

2. How can payers prevent missed AI opportunities in healthcare?

Ans: Payers must quickly embrace AI-driven healthcare solutions to avoid being left behind. This involves creating strategic plans and ensuring readiness to respond to competitors with lower costs or higher efficiencies.

3. What steps can payer CEOs take to capture AI opportunities in healthcare?

Ans. Payer CEOs should establish governance frameworks, mobilize their organizations to pursue AI integration, and begin asking tough questions to prepare for the future of AI in health insurance.

4. What are the key considerations for successful AI integration in payer systems?

Ans. Successful AI integration in payer systems requires understanding the economic opportunities, assessing readiness, accessing AI talent, and reimagining processes in key domains such as claims, network and contracting, utilization management, care management, and information technology.