In June, Becker’s predicted that 2025 would shape up to be the year of AI agents in healthcare. While AI agents are nothing new, more insurers are getting on the bandwagon.
AI agents complete tasks autonomously to achieve specific goals. More broadly, though, AI use in health insurance has been contentious. CMS released AI guidance for Medicare Advantage plans in an effort to prevent bias with coverage decisions, and state regulators have even joined the conversation.
Traditional Medicare will also be subject to AI-driven prior authorization processes by means of a CMS pilot launching next year in some states. However, the American Hospital Association has pushed the agency to delay the initiative.
Despite this overall unease, health insurers have been implementing AI tools and agents, specifically.
The Wall Street Journal reported UnitedHealth Group has 1,000 AI use cases, ranging from transcription tools to claims processing support. Consumer calls make up one cornerstone for AI agents, though. In April, UnitedHealth’s former CEO said, by the end of the year, he anticipated AI will direct more than half of all customer calls. SCAN Health Plan and Elevance Health have also been harnessing AI in their call centers.
Oscar Health’s AI agent, Oswell, will have both member- and provider-facing capabilities. Along with helping members unpack test results, prescriptions and symptoms, the AI agent can also supply providers with patient data insights.
AI agents have been used for more specific markets, too. In New York City — home of EmblemHealth — approximately 500 people die due to extreme heat each year. With EmblemHealth’s weather-resilience program, the payer can identify members who may be at risk of heat-related illness and provide them with resources through AI voice agents. EmblemHealth plans to expand the program to encompass other weather circumstances.