5 strategies you can use now to help healthcare consumers compare costs, using AI

Consumer directed health plans (CDHPs), price transparency, and other levers were meant to encourage healthcare consumers to compare costs and make cost-conscious decisions.

But here’s the hard truth: these solutions are not working.

Too often, consumers who try to compare costs end up feeling frustrated and confused. Everything about the experience—from what services they’ll need, to how and where to search for lower-cost options, to what their plan covers and doesn’t cover—is  incredibly complex. 

Barriers between consumers and cost savings

To compare costs, healthcare consumers need to know:

But there are ways to help consumers take charge of their healthcare spending. 

These 5 strategies can help your organization engage with consumers and move them from overwhelm to action.

1. Think beyond high-cost procedures: Small savings can have a big impact

It’s tempting to focus solely on high-cost procedures when searching for savings. And many health plans do have some luck with assigning a navigator to members who are receiving high-cost care, like a surgery. 

But sometimes, the more actionable savings are in smaller, frequently repeated services instead of surgical procedures. 

Lab tests, for example, can feel easier for individuals to act on. This is where AI-powered analysis and machine learning can truly shine, highlighting costs that seem small at first glance but add up significantly over time.

This data, which comes from CareHive’s book of business, proves the point. In one year, lab services made up over 38% of the possible savings for the health plan among the top services that could be redirected

Savings potential over one year
Among the top steerable services

2. Invest in mining the claims data so consumers don’t have to interpret it

AI is changing the game when it comes to navigating data. AI-powered analytics can sift through claims data to understand the episodes of care within the data, and then match those care episodes with pricing information to understand where there are lower-cost alternatives within the network. 

AI has the power to do this at scale, uncovering and leveraging trends and opportunities, and helping avoid risks so decisions are as data-driven and informed as possible. 

3. Harness the power of multiple data sources

Getting all of this done isn’t easy. One of the biggest challenges to true price transparency is that the available data is often incomplete or inconsistent. 

For AI to generate meaningful insights, it needs high-quality, comprehensive information. By integrating data from multiple sources, including past claims and other sources, AI can piece together a more accurate and reliable picture of the healthcare landscape.

4. Personalize cost savings to each consumer’s plans and needs

The future of cost-saving strategies lies in deep personalization—and this is precisely why AI is the perfect tool for the job. 

Using care protocols and past claims data, AI can predict when a health plan member might need certain types of care in the future, such as high tech radiology (i.e. MRIs).

The future of cost-saving strategies lies in deep personalization—and this is precisely why AI is the perfect tool for the job.

5. Humans must be part of the experience

No matter how sophisticated AI becomes, it can never fully replace the human touch. 

Healthcare is a deeply personal issue, and making decisions can feel overwhelming. Consumers need to know they are not alone and that there is someone they can call as they make important changes. They must have access to a human navigator who can help guide them through questions, concerns, and the decisions they need to make to turn AI-powered insights into action. 

Putting it all together is CareHive

CareHive isn’t just improving healthcare navigation. We’re changing the game for the better. By harnessing the power of AI and data using these and more strategies,  CareHive provides clear, proactive guidance to our members so they are empowered to make decisions that take cost into account.

Along the way, we help our members make the changes they choose to make in where they get certain health services.

Interested in seeing how we do it?