Why health insurers must embrace GenAI innovation now

Generative AI poised to transform health insurance industry: Health insurers are exploring generative AI’s potential to revolutionize both back-office operations and complex processes that impact employee and member experiences.

Current challenges and opportunities: The health insurance sector faces significant hurdles in its digital transformation journey.

• Black Book estimates that poorly performing, outdated IT systems cost the healthcare industry $8 billion annually.
• Successful implementation of generative AI-powered transformation requires substantial investments in robust, agile technical infrastructure.
• Health insurers must also develop internal capabilities and readiness for strategy and change management to fully harness generative AI’s potential.

Key applications of generative AI in health insurance: Early adoption of generative AI offers several benefits for health insurers.

• Expedited care coordination through digitized intake processes and automated clinical reviews for prior authorization and care management.
• Enhanced customer insights derived from analyzing interaction data during routine activities and high-value moments.
• Improved knowledge management via conversational experiences, utilizing large language models (LLMs) in contact centers and internal chatbots.
• Elevated member experiences across the entire lifecycle through healthcare-specific LLMs.

Strategic considerations for health insurance leaders: The rapidly evolving landscape of generative AI applications presents both opportunities and challenges.

• Health insurers should align on values, principles, and goals at an enterprise level rather than a functional level.
• Senior leaders must decide between reimagining every function within their organization or pursuing a more measured approach through small pilots.
• Augmenting staff abilities and enhancing consumer experiences are potential areas for initial experimentation.

Ongoing research and industry involvement: The impact of generative AI on healthcare continues to be a subject of intensive study.

• Forrester’s research on generative AI in healthcare is ongoing, focusing on core issues, new security implications, and opportunities for employees.
• Healthcare organizations are encouraged to participate in research interviews to contribute to the evolving body of knowledge.
• Forrester clients have access to guidance sessions and inquiries to explore how health insurers are leveraging generative AI.

Implications for the future of health insurance: The adoption of generative AI technologies has the potential to significantly reshape the health insurance landscape.

• Improved efficiency in care coordination and authorization processes may lead to faster, more streamlined healthcare delivery.
• Enhanced customer insights could result in more personalized and responsive insurance products and services.
• The transformation of knowledge management and customer service operations may significantly improve both employee productivity and member satisfaction.