TEC H N O LO GY
Current and Future Power of AI to Improve Care and Elevate the Member Experience
By Dr. Arta Bakshandeh
The article describes how artificial intelligence (AI) has improved patient care and member experience at Alignment Health over the last decade, and the potential for AI to do even more to help improve care for all people in the future. While we include examples of how we are using AI at Alignment, the broader message is how AI can be integrated into the insurance industry with beneficial results. Over the last decade, artificial intelligence (AI) has elevated the member experience and dramatically improved the level of patient care we can deliver. As Alignment Health’s chief medical informatics officer, I can say I’m a true believer that it will only get better from here. Let me share a story to put into perspective just how far we’ve come as an industry, with the integration of AI. In December 2018, a member called into our 24/7 concierge care line with dangerously low blood sugar levels. As a senior medical director for Alignment at the time, I took the call and the member began describing his current situation and symptoms. As he spoke, I could click into our AI-powered platform — AVA®—to gather important context around his situation. According to AVA, this member lived in a low-income area with no nearby family or access to urgent care. He was on his own, and I needed to give him immediate guidance on what to eat and how to adjust his insulin pump. But like many seniors, this member was dealing with food insecurity, and unfortunately that night, there was no food in his fridge. Acting quickly to gain control of his blood sugar levels, I ordered the member a large pizza, and it arrived while we were 22 | CALIFORNIA BROKER
on the phone. By 9 a.m. the next day, Alignment’s care team was in the patient’s home, and by the end of the day, he was set up with appropriate nutrition from Meals on Wheels. A $20 pizza prevented a potential $2,000 ER visit and, more importantly, serious health consequences for our member. None of that would have happened without the context provided by our AI-powered clinical care model. The “pizza prescription” is just one of many examples of how AI technology can empower both care teams and members across the industry. Over the last decade at Alignment, AI has evolved into a powerful tool that collects thousands of real-time, actionable data points and, in turn, presents us with a “whole person” picture of our members. In moments where we have traditionally been confined to reviewing lab work, we now see the other 80% of the “picture” that really contributes to health outcomes: Did our member pick up a prescription? Is our member at risk of a hospital visit? With AI, we can make things that used to be inevitable, avoidable. Here are a few of the most powerful AI impacts I’ve witnessed over the last decade that are applicable to many situations and not exclusive to Alignment Enabling a proactive stance in our most vulnerable populations With greater data visibility comes a more focused, proactive care delivery. In Alignment’s case, AVA enables exponential efficiencies for our physicians and their care teams. AVA
CalBrokerMag.com
DECEMBER 2023
