Payer

Embrace Digitalization with Xenolytix

The pandemic stands to have an outsized impact on the Payer industry for years to come. It accelerated the need for solutions practically overnight and it so efficiently highlighted known gaps in the healthcare system – including how far behind many stakeholders are digitally – it is the source of the primary drivers for healthcare payer technology. Health plans must take care of these in the coming year or risk falling even further behind.

Health plans have access to a large goldmine of timely, medical, pharmacy, and hospital discharge data. The data comes in real time and needs to be made actionable. Payers can drive operational efficiencies, predict epidemics, prevent diseases from spreading, calculate premiums accurately, and improve member experience through digitally enabled healthcare payer solutions. Health plans that are able to adapt to these changing trends are far better positioned for long-term success.

This is all a part of a larger trend around creating a more value-based healthcare system that puts the patient at the center of the care journey. New data-driven technologies are spurring digitization and automation across the board. Machine Learning can aid in processing claims, assessing and evaluating new policyholders, determining risk level, as well as predicting future incidents. It is also powering different chatbots that can provide efficient customer service through websites and mobile apps. Using IoT, Payers can enter the interactive insurance model. They can give members IoT enabled fitness wearables that can record and share fitness and health status information – in exchange the policyholders can get rebates, lower premiums, or gift-cards. Policyholders also get extra motivation to pursue a healthier lifestyle, and Health Plans obtain useful data regarding their customers.

At Xenolytix, we understand the importance of becoming digital. We use the latest emerging technologies to transform Health Plans / Payer’s business functions. Embrace Digitalization with Xenolytix.

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Claims Processing

Real-time claims processing using Machine Learning.

Member Engagement

Leverage cognitive automation to power emotionally intelligent, real-time interactions with policyholders.

Virtual Care

Provide access to care management and risk assessment digitally.

Health Outcomes

Address social determinants to gain insights & improve outcomes using Data Science.

Reimagine the Claims Processing Workflow

Technological disruption has come to the insurance industry — and the smart risk management strategy is to embrace it.

Machine Learning is a force multiplier. It helps connect, augment, explore, and analyze disparate data sources to discover the underlying drivers of outcomes and gain actionable insights. . Up to 70% of claims are flagged as unusual and then passed to administrative staff to review in detail. Many are flagged incorrectly. Machine Learning helps limit the initial number of claims flagged as unusual. The conventional approach to claims management based on an inflexible rule book has been made obsolete by intelligent algorithms that learn from historical cases and continuously evolve.

Blockchain offers tangible and practical solutions to significant issues plaguing the insurance sector, creating a more productive environment for both the company and the customers. With its secure structure, blockchain streamlines the processing of paperwork and offers complete control of personal information to individuals. The cryptography feature in blockchain can bring in an element of security by making transactions valid, authenticated, and transparent. With real-time collection and analysis of data, blockchain fast-tracks the processing and release of claims. Blockchain can act as a shared ledger for the insurance data, thereby serving as a single source of truth. Smart Contracts significantly reduce paperwork in the insurance processes to increase the quality and quantity of output with lower costs of operations. Moreover, the distributed, decentralized public ledger makes blockchain a useful tool for detecting and preventing fraud.

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Revolutionize The Trust That Powers Insurance

Managing the Health Plan has become cumbersome, frustrating and wasteful. Complex rules and regulations, multiple parties coordinating care, antiquated systems, manual processes and more have contributed to unnecessary spending and write-offs.

A policyholder typically consults a multitude of medical specialists in a lifetime. Managing data between so many parties is a cumbersome process. A cryptographic blockchain facilitates a synchronized & secured process of sharing data between parties without compromising the patient’s privacy. A system of medical records maintained on the blockchain can store a cryptographic time-stamped signature of every file, allowing insurers to audit relevant medical information on a use-case basis without infringing the privacy of the policyholder.

Prior Authorizations are a challenge. They take time, they delay care, they waste resources, and frustrate providers and policyholders. With Blockchain, payers and providers can collaborate on prior authorizations via a private, permissioned distributed ledger. Payers would follow their existing processes to create billing documents, member lists, etc. But instead of publishing static files or exposing information via websites or APIs, they populate the ledger or network with the same information. Those relatively simple steps would completely remake the prior authorization process and drastically reduce the cost for everyone.

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Stay on Top of Their Minds

There is a deep, multigenerational, and growing demand from health plan consumers for more and improved digital interaction with payers. Digitally native companies like Amazon and Netflix have taught policyholders to expect best-in-class digital and live-person channels, content tailored to their interests, and a seamless journey focused on their individual needs.

For health plans looking to streamline member communications without impacting service levels, omnichannel is the answer. Chatbots using NLP can accurately give voice to the unstructured data of the healthcare universe, giving incredible insight into understanding quality, improving methods, and better results for patients. Conversational AI / NLP has given rise to the Automated Insurance Agent that can play a critical role across the health plan value chain – pre-purchase, purchase, and customer care. NLP can help increase online health plan policy sales, automate query management, decrease claim handling time, and vastly improve customer satisfaction by making it easier for consumers to understand confusing insurance terms.

It helps policyholders get the most out of their health insurance premiums and make better health plan choices.

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