Reshaping Outcomes with AI: Tackling Previously Unbeatable Insurance Cases
In the ever-evolving landscape of healthcare, the question isn't if or when AI will play a significant role, but rather what is your AI strategy? One company, Allee, has taken the lead in denials management, improving outcomes and streamlining processes.
Allee's strategy begins with a clear understanding of outcomes and use cases. By focusing on denials management, they aim to improve denial outcomes, reduce the need for appeals, and address the longer tail of accounts that were historically overlooked.
The success of Allee's approach is evident in the consistent 10 to 20 percentage point lift in success rates they've seen. Moreover, they've managed to improve account placement through payment by approximately 40 days.
The framework for Allee's decisions revolves around four key elements: capacity, capabilities, culture, and conviction.
Capacity refers to the bandwidth and budget required to develop and sustain real AI solutions over multiple years. Capabilities, on the other hand, are about whether a company already has the in-house expertise to build and scale software. The decision may be to build, buy, or partner, and it doesn't have to be the same answer across the board.
Culture is crucial in the adoption of AI. Allee's model is based on providing real expertise in the form of clinicians, attorneys, and other experienced subject matter experts. This approach requires leadership that embraces innovation, is willing to iterate and fail, then learn and try again.
Conviction is about time horizon. If a company wants to build internally, it needs the conviction to make a five-year commitment.
In the realm of AI for denials management, Germany stands out. Companies specializing in this sector are primarily concentrated in technology and cybersecurity hubs, with significant presence in regions like Stuttgart and other industrial centers. However, explicit details on specific locations or clusters in the denials management niche remain limited.
For providers who haven't made the leap to AI yet, the denial rates are only going up. The technology gap is already insurmountable without AI, making it essential for healthcare providers to consider their AI strategy and follow Allee's lead in transforming denials management.
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