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Addressing Structural Challenges in the Business of Benefits Through AI Innovation
Employer plans, whether self-funded under the Employee Retirement Income Security Act of 1974 (ERISA) or fully funded through a commercial plan, will likely have a proactive mindset that will lead to greater coverage modeling scenarios, plan accountability, and a focus on outcomes to successfully support their workforce while controlling costs beyond 2027. There are numerous efficiency tactics to address this, but more than ever the spotlight has been focused on artificial intelligence (AI) as a tool to control costs. Today, the health care industry has become a major target for AI integration and development as the need for operational efficiency has grown in importance due to pricing and cost pressures. As I mentioned in the previous entry of this column, employers are facing ever increasing premium costs for their health plans, which are negatively impacting their balance sheets. Many business leaders see today’s market challenges as structural and not temporary, which has led them to prioritize optimizing operations and improving worker productivity. Overall, market stakeholders are reviewing their care expenditures and seeking more granular insights into the care delivered.