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TELUS Health Annual Conference 2024: How AI is reshaping the benefits landscape

Generative artificial intelligence (AI) is a "transformative milestone" that will change our world on the scale of technological developments such as harnessing electricity, creating the semiconductor and building the Internet, said Simon Bédard, CEO and Co-Founder of Clinia, at the 20th TELUS Health Annual Conference in April 2024. 

"It’s truly a watershed moment for our society," Bédard stated at the 20/20 Health Tech Insight panel moderated by André Picard, health reporter and columnist for The Globe and Mail. 

However, he emphasized, it has to be done right. "In health, … we need to get it right every time, as people’s lives are literally depending on it. So I would go as far as to say that generative AI needs to be health-grade, purpose-built for the needs and demands of health."

Bédard said accuracy, privacy and security must be top priorities as AI is developed and implemented, alongside conforming to regulatory frameworks such as the U.S. Health Insurance Portability and Accountability Act (HIPAA), European General Data Protection Regulation (GDPR) and Canadian Personal Information Protection and Electronic Documents Act (PIPEDA).

"We believe that data can be used and leveraged for good to improve the speed of accessing the right treatment based on your individual health situation and your past health history, and ultimately optimize health system efficiency, cost and outcomes."

Enabling seamless connections across platforms

"The stage is set for private payors to take the helm in driving healthcare transformation," said Colleen Adams, Director of Business Enablement at TELUS Health, in her remarks. 

She pointed out some of the ways technology has already transformed the payor space in areas such as claims adjudication, benefits payments, enrollment and customer service. Technology has increased efficiency, reduced errors and streamlined operations, while embedding data analytics to identify trends, patterns, insights and fraud.

AI, she continued, will support the evolving relationship between members and payors from transactional to meaningful – from paying claims to enabling access to care. It will also help to integrate fragmented experiences in plans where multiple vendors provide health solutions wrapped around core drug, health and dental coverage.  

"AI will enable deeply personalized journeys within health plan ecosystems," said Adams. "AI will enable a holistic and real-time health view of a member. Data will constantly be ingested for ongoing learning and analyzing to deliver smart recommendations for health services [to] keep members on track to a path of better health, with proactive nudges for health management, and identify early risks for health intervention."

Lighting the way towards interoperability

Unseen by members, but critical to payors, advancements in technology are also poised to drive forward interoperability within the Canadian healthcare system, said Ratcho Batchvarov, General Manager of Electronic Medical Records at TELUS Health. Our healthcare system, characterized by its provincial governance, presents unique challenges in standardizing the exchange of health information. This has historically led to silos of information, hindering the efficiency of healthcare delivery and impacting patient care. Recognizing that technology alone can't solve this puzzle, our federal government is shifting its perspective, understanding that legislative reform and a unified approach are essential. Canada Health Infoway’s Shared Pan-Canadian Interoperability Roadmap is an example of a transformative  initiative, he said, to bridge divides between disparate healthcare systems, set the stage for national standards in data exchange and ensure that health information moves seamlessly with patients.

Batchvarov described two specific opportunities currently under exploration, to improve interoperability between medical records and payors: the streamlined processing of disability forms and electronic prior authorization. AI has a role to play in both.

For example, AI can automatically extract patient information from electronic medical records, filling out disability forms and submitting them to payors, validating the information against predefined rules and historical data to ensure accuracy and even analyzing past submissions and outcomes to predict the likelihood of form approval.

With electronic prior authorization, by analyzing a member’s prescription and insurance coverage in real time, AI can automate the initiation and processing of requests directly from the electronic medical record and provide real-time decision support – for example, suggesting alternative medications or treatments that don’t require prior authorization or are more likely to be approved by the plan.

"The path forward is illuminated by strategic initiatives, technological advancements and, most importantly, the collaborative efforts of all stakeholders in the healthcare ecosystem, including private payors," said Batchvarov. "The journey towards interoperability is a shared endeavour – one that promises to redefine healthcare in Canada, making it more integrated, responsive and especially patient-centred." 

Taking next steps towards an AI-enabled future

Asked about next steps for payors, Adams cited findings from the 2023 Benefits Canada Health Survey that showed members want to receive recommendations for services covered by their benefits plan.

"They want those proactive nudges and the connection points," she said. "Step one is to really look at your current state, imagine where you want to be in your future state and then paint the picture of how to get there," she said. "It doesn’t have to be a 100% [mapped out] journey on day one. It’s taking those smaller actionable steps to continuous improvement."

The key for payors, Bédard said, is to move quickly towards structuring teams and defining key performance indicators and returns on investment, starting small and evolving.

"Things move so fast in AI that, in an industry that has historically been slow to integrate and adopt new technology, payors who start now will create a big advantage for themselves – and those who don’t will have a hard time competing."

View the presentation deck from the roundtable discussion: