Health insurance organizations expect generative AI (genAI) to transform healthcare. They’re experimenting to unearth its potential to both automate back-office tasks and to tackle complex processes to elevate the employee and member experience. But both health insurers (HIs) and healthcare provider organizations are starting this journey with poorly performing, outdated IT systems, which Black Book estimates costs the industry $8 billion annually. GenAI-powered transformation can only happen if HIs invest in sturdy, agile technical infrastructure. Just as importantly, they also must develop internal capabilities and readiness for strategy and change management to gain genAI’s true potential in their workflows.

My new report, Generative AI: What It Means For Health Insurers, dives into genAI’s impact on HIs and examines avenues for early adoption and ways to circumvent potential risks. Some early benefits of genAI applications for HIs are:

  • Expediting care coordination through digitizing the intake process. Automating clinical reviews for prior authorization and care management rapidly increases care coordination and prevents delays in care.
  • Gaining contextual insights from customer interactions. By analyzing customer interaction data during typical activities (e.g., searching benefits) and high-value moments (e.g., renewal), HIs can better comprehend how members perceive their products, services, and overall experience.
  • Enabling knowledge management via conversational experience. Employee productivity tools powered by large language models (LLMs) in contact centers and internal chatbots help customer service agents resolve customer issues efficiently.
  • Enhancing the member experience. HIs can use healthcare-specific LLMs to automate and improve experiences across the member lifecycle.

How Can Healthcare Leaders Stay Up To Date On Generative AI?

GenAI applications are evolving rapidly, and keeping a pulse on who, when, where, why, and how is challenging. HIs should align on values, principles, and goals at an enterprise level — not a functional level. Senior leaders must decide whether they want to reimagine every function within their organization or pursue a more measured approach, such as augmenting their staff’s abilities or consumer experiences in small pilots.

How Can Healthcare Organizations Get Involved In Upcoming Forrester GenAI Research?

My research on generative AI in healthcare will continue as healthcare organizations navigate core genAI issues, new security implications, and the impact on and opportunities for employees. Also, see Forrester’s dedicated genAI theme page for more insights and guidance.

If you would like to participate in our research, please contact me (sgermain@forrester.com) to schedule a research interview. And if you’re a Forrester client, let’s talk via a guidance session or inquiry to explore how HIs are tapping into genAI.