As an agent, you are key to helping clients navigate their health plan options — including using technology to deliver personalized care, improving service quality, reducing costs, and enhancing the patient experience. This post explores how technology is transforming health insurance and how you can use these tools to better serve your clients and their employees.

Streamlined Claims Processing with Automation

In the past, health insurance claims involved paperwork, delays, and errors. Today, automation is streamlining the process. TPAs are using automated systems to process claims faster and more accurately. You can inform clients and employees that automation reduces wait times and improves processing accuracy.

Through our partnership with Smart Data Solutions (SDS), automated systems enable us to quickly verify claim validity by cross-checking patient information, policy details, and medical records. This reduces administrative workload, improves transparency, and ensures a smoother, more accurate claims process for employees.

Personalizing Care with Data Analytics

Personalized care customizes treatment to an individual’s needs, using data analytics to gain insights from medical histories, lifestyle, claims, and preferences. PAI uses this data to design plans that address employee or client needs. By analyzing healthcare history and preferences, we offer targeted care, reduce unnecessary treatments, and manage costs, improving outcomes. By partnering with Health [at] Scale, we’ve taken this a step further by enabling providers to refer patients to the right providers based on their claims data.

PAI Analytics® also empowers agents and employers by transforming complex data into actionable insights. With powerful tools like predictive analytics, cost-saving optimization, and automated reporting, PAI stays ahead of trends, reduces risks, and delivers optimal health plans. By utilizing clear, detailed reports and personalized recommendations, PAI enables you to enhance client satisfaction and streamline operations.

Predictive Care with AI and Machine Learning

Advances in Generative AI are revolutionizing healthcare, and PAI is committed to utilizing these technologies as tools to help support our mission to make benefits better.  

Within our analytics tool, AI can help identify members who are at risk for future conditions or large claims.  Predictive care helps manage plan spend more efficiently, offering employees support before serious health issues develop and ultimately reducing long-term healthcare costs.  When reviewing medical records, AI technology can extract the key pieces of information needed to assess the member’s condition and the appropriateness of care.   AI technology will not make denial decisions for us, but it can allow us to focus on a thorough review of complicated cases by handling the easy approvals.  

The next frontier for using this technology is helping identify the right provider for referrals.  Partnering with Health @ Scale, an innovative company that integrates member claim data into cost/quality metrics.  This allows us to drill down when identifying the “best” provider in an area, taking into consider member-specific conditions, and having AI technology filter through results data to identify who the best provider is for that particular member.  Getting this information into the hands of Primary Care providers at the time that they are discussing referrals with their patients is our next focus.

The proliferation of technology can be overwhelming.  That is where PAI can help support our clients, as we are constantly evaluating new solutions and vendor relationships, choosing to partner with only the very best ones to bring value to our client partners.

Telemedicine: Connecting Care Anytime, Anywhere

Telemedicine represents a leap forward in delivering personalized care. Through telemedicine platforms, employees can consult healthcare providers remotely, simplifying the process, saving valuable time, and eliminating the need for travel. Our partnership with First Stop Health helps make this a seamless experience.

Recommending telemedicine as part of a health insurance package not only enhances employee satisfaction by offering convenience and minimizing disruptions to their workday, but it helps lower overall healthcare costs. By providing employees with the ability to receive care remotely, you can reduce unnecessary emergency visits, contributing to a more cost-effective and efficient healthcare system.

Mobile Apps for Easy Access and Engagement

Mobile apps have become essential tools in by offering employees easy access to their health insurance benefits, claims status, and medical information. PAI provides My Benefits Manager a secure, one-stop platform for all the tools employees need to manage their benefits. It provides easy access to information specific to their benefit plans, including:

• Email Customer Service: Get in touch directly for assistance.
• Find a Network Provider: Search for in-network healthcare providers.
• View Plan Documents and Benefit Summaries: Access detailed plan documents and summaries.
• Access Claims and Explanations of Benefits (EOBs): Track and review claims status and details.
• Print, View, Share, or Request an ID Card: Manage your ID cards easily.
• Access Pharmacy Benefits: View pharmacy-related benefits and coverage.
• Access Forms: Download important forms for your benefits.
• View Member Discounts and Value-Add Programs: Explore discounts and additional programs available to you.

Members can log in at www.paisc.com or download the My Benefits Manager mobile app for easy access to their benefits anytime, anywhere.

A Future of Personalized, Efficient Care

As technology advances, health plans are becoming more personalized and efficient. By adopting innovations like automation, predictive care, telemedicine, and secure data sharing, agents and HR professionals can help clients and employees navigate healthcare more effectively. These tools ensure better care and an improved health insurance experience, benefiting both employees and employers by making healthcare more accessible and tailored to individual needs. 

Ready to take your health plans to the next level? Contact PAI today to learn how our analytics can drive smarter decisions, better outcomes, and lower costs for your clients.