4 min. read

Gartner expects 40% to 50% of healthcare payers to have an AI strategy by 2022, terming it as a sufficient mainstream adoption that has quickly advanced in the last two years. It’s time to understand the drivers of this paradigm shift, how early adopters are benefitting, and Fractal’s role in aiding healthcare payers.

AI is game-changing, especially in the healthcare payer sector where the healthcare context and the member’s journey differ from case to case. This coupled with policy and administrative changes, and the uncertainties of the COVID 19 pandemic, are driving payers to recalibrate their competitive advantages. Typical IT solutions are never going to be enough. The need of the hour is to embrace change, to be adaptable and agile to meet emerging needs.

The answer lies in AI, engineering, and design - to understand market demands, customer context, policy regulations, and to combine this with enterprise vision and capabilities. This is how enterprises build composable architectures; with a future-proof AI strategy.

Payer CIOs have consistently acknowledged the power of AI and analytics, but fail to drive impactful AI adoption in their enterprise as a result of several factors.

Reasons for sub-optimal AI adoption in healthcare

  • Incoherence in AI execution and enterprise strategy
  • Lack of a clear AI vision, resulting in pilot runs with generic innovation mandates
  • Fear of missing out as early adoptive competitors achieve real outcomes with AI
  • Organizational bias and misperceptions about AI capabilities and threats
  • Settling for one-off solutions without AI strategy or governance
  • Discounting the current state of AI, focusing on early projects that have under-delivered

At Fractal, we believe that change begins with a sound AI strategy powered with human-centered design integrated with a strong engineering and deep domain expertise.

We take pride in being listed as a vendor in this space by Gartner’s hype cycle report. To help healthcare payers drive better decisions with AI, we focus on four key areas with a common intention to help members live healthier and happier lives.

Customer journey analytics

In healthcare, the Customer Journey Analytics (CJA) market remains highly fragmented. It denotes the process of tracking and analyzing how customers and prospects use a combination of available channels to interact over time. Fractal’s Customer Journey Analytics tracks to understand members’ real needs based on social interactions, administrative touchpoints, socio-economic, clinical trajectory, and other related contextual data. Fractal’s solutions focus on building better member aka CJA, by mining through millions of member’s digital touchpoints, along with external and omni-channel data to uncover several microscopic factors that cause dissonance using a series of unique pattern recognition AI algorithms.

Integrated member retail experiences

Personalization has set benchmarks in delivering a good brand experience, especially with the onset of the pandemic. Healthcare organizations are rapidly adopting virtual enablement strategies and tools to engage. However, payers especially have challenges driving engagement through member portals with low engagement and utilization rates. Support-driven interactions, acquiring the right customers, and enhancing customer experience to retain loyalty are key areas that have been uplifted with adoption

Fractal recognizes the complex orchestration of every experience a consumer has with a payer that wins or loses their loyalty and health engagement. We play a critical role in understanding factors beyond just care, looking deep into the individual’s context at every level, and integrating this into the AI layer

We focus on building health experiences with hyper-personalized interactions powered by addressing customer’s specific needs and drivers for member dissatisfaction levels with the next best action recommendations.

Payment integrity solutions

There is a paradigm shift from postpay to prepay and pre-emptive billing intelligence layer driven by cost containment and operational excellence strategies for payers.

Fractal focuses on decreasing the current claims spend, reducing the percentage of claims requiring rework, and reducing the cost per claim processed over a specific timeframe

We empower enterprises to save massively on administrative time, achieve improved efficiency and productivity across both the post & prepay phase of claim auditing. Like the Microlens (micro segmentation) framework and anomaly detection tools, many of our internal accelerators are designed to better identify claim aberrancies and flag anomalous claims. There is a lot of untapped potential to abstract unstructured data from network contracts and clinical notes from medical records that will help uncover opportunities in the earlier stages of the claim audit cycle, improving audit accuracy and efficiency.

Healthcare consumer engagement hub

Healthcare organizations have begun investing in supplemental CRM systems to document engagement beyond line-of-business interactions. Still, they only capture a fraction of the data a consumer generates as they interact with their health. Payers realize creating longitudinal insight requires data aggregation from many business partners and independent data sources

Fractal’s member engagement strategy is built to engage with the end-user throughout the care journey. It encompasses their clinical pathways, post-acute journeys, population health, and member behavior-centered chronic care strategies.

We understand chronically ill individuals require continuous intelligence and analysis of multiple health indicators, events, and actions from an expanding array of technologies around the body. While addressing the need for better outcomes, Fractal focuses on creating connected care pathways that bridge consumer and clinical services in the long run.

Gartner’s hype cycle report shows that AI strategy for healthcare payers is at the slope of the enlightenment phase. There is a more crystallized understanding of how enterprises can benefit through AI adoption. More and more enterprises are also funding AI pilots with the expectation of moving towards full-blown adoption. In this regard, there are a few recommendations to consider.

Gartner’s recommendations to healthcare payers

  • Create an AI strategy and maintain it with a cross-functional team to unify initiatives and draft consistent measures of progress.
  • Incorporate an AI strategy into the enterprise data and analytics strategy or combine business and technology strategy.
  • Manage stakeholder expectations about the state and impact of the technology.
  • Modernize the enterprise analytics architecture, especially the data science workbench and the decision hub.

Fractal is a committed partner to healthcare payers to achieve these recommendations and go above and beyond to help achieve the enterprise vision. All this simply by establishing the AI strategy you need.