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Hospitals & Healthcare

Emerging AI in medical travel and insurance

Hospitals & Healthcare
3 Feb 2025 | Irving Stackpole
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Illustration of AI in healthcare

Irving Stackpole uncovers how artificial intelligence is transforming the way patients interact with healthcare providers, and how insurance companies can capitalise on new technology

Unstoppable economic forces are pushing us toward collisions in travel, medical travel and the insurance sectors. The emergence of artificial intelligence (AI) will transform these markets, and our experience of them. People are travelling more, going across borders for health, wellness and medical services, and purchasing travel insurance. The convergence of these three dynamics – travel, insurance and AI – demands our attention. Being aware and informed enables us to realise the benefits, accept change and manage controversies.

Data and historical information about fraud is being pooled into large data sets and used to more accurately anticipate inappropriate claims submission

Along with the growth of international travel overall, there are more health tourists: people seeking health, wellness, and medical services abroad. Reliable data on international medical travel is available in only a few regions, but evidence of this growth is seen in the increasing demand for health, wellness, and medical services. For elective ‘lifestyle’ services such as cosmetic procedures, the key drivers appear to be access and price, while for more complex medical services such as elective surgery, the key drivers are availability and wait times.

Role of AI for insurers

The increase in global travel corresponds with travel insurance providers using various tools in the AI toolbox to help the bottom line, attract and retain existing customers, manage claims and detect fraud.

Efficiency is one of the key drivers of the use of AI by the insurance sector. The business is characterised by high administrative burden: so much of the operation relies on repetitive tasks handled by agents, adjusters and a host of other operatives. This explains why insurance businesses are among the early adopters of new technology. Whatever can reduce the need for human time and effort, especially repetitive tasks, without sacrificing accuracy and improving reliability, can often be cost-justified. Digital scanning and optical character recognition (OCR) are good examples. AI offers entirely new horizons for efficiencies.

Risk assessment and pricing are also being transformed by AI: with large-scale claims data, insurance providers are better able to estimate risks, in real time, more accurately, and price products accordingly. The historical pricing models, built on actuarial tables and global risk estimates, either over- or underestimate real risk. Predictive analytics allow greater accuracy and reliability. These analytics help increase the bottom line and accurately adjust premiums.

Personalisation is another area where AI is making a huge impact. Using claims and demographic history, travel insurance providers can tailor travel insurance packages at a personal level, targeting the needs of particular travellers in specific regions. This personalisation attracts more insurance consumers and creates higher levels of loyalty.

Finally, AI is making waves in fraud detection and prevention. The cost of fraud in insurance markets is a source of waste. Data and historical information about fraud is being pooled into large data sets and used to more accurately anticipate inappropriate claims submission. Reducing inappropriate claims and the associated administrative costs and payments (whether fraudulent or erroneous) improves the bottom line, allows for more accurate and profitable pricing, and expedites claims adjudication.

The consumer experience transformed by tech

Improving the consumer experience is a top strategic goal along every touch point in the travel value chain. The application and use of new technologies and AI are already delivering on their promise.

AI-powered health monitoring

The sophisticated decision-support tools used by doctors and healthcare professionals at major medical centres are now available through AI-enabled apps on smartphones. This enables travellers to undertake adventures with the confidence that, should something untoward happen, resources and advice are close at hand. For travellers with disabilities, or those who have chronic health conditions, a suite of mobile monitoring tools travel with them. These tools open up enormous potential for travel advisers and destinations to attract these large markets, which in the past have not been well served.

The sophisticated decision-support tools used by doctors and healthcare professionals at major medical centres are now available through AI-enabled apps on smartphones

In the medical travel markets, devices also empower virtual health assistants for pre- and post-procedure support.

One of the difficulties associated with medical travel has been the lack of proper follow-up. Telehealth and AI-enabled monitoring devices are increasingly being used to address these challenges in delivering smoother and safer transitions of care from clinic to home – wherever that is.

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More accurate and speedy claims processing

The perennial problem for brand loyalty in the insurance markets is delays in claims processing. The use of historical claims data coupled with machine learning allows insurance providers to reliably predict and process ‘clean’ claims quickly, while accurately flagging those requiring more scrutiny.

Travel advisories and safety alerts

Travellers come in all shapes and sizes, and with vastly different risk profiles. Large language learning models, together with predictive analytics, can more accurately and reliably advise clients – even those with high risk tolerance – regarding their safety. These tools are also being used to coordinate emergency evacuations. 

Illustration of a laptop

Process optimisation

One of the historical hallmarks of both the insurance and healthcare industries is their administrative burden. Wherever efficiencies can be gained in the insurance business, the bottom line is improved. AI tools are being applied vigorously to reduce the administrative costs and improve the financial health of  insurance providers. Eliminating administrative redundancy and avoiding unnecessary processes or tasks are challenges perfectly suited to the new AI-enabled technologies. The capital costs to deploy these new technologies are justified through cost avoidance, increased efficiency, improved customer satisfaction and fraud reduction.

AI tools are being applied vigorously to reduce the administrative costs and improve the financial health of insurance providers

Ethical considerations and challenges 

There is a host of legal and ethical considerations associated with the deployment of the sophisticated and powerful AI-enabled tools in the travel, health and insurance markets.

Industry groups and governments are struggling with these questions, even while technology races ahead of standards development and regulatory guardrails.

  • Balancing AI with human oversight – The ethical discussions about coverage decisions assume that human interaction should always be involved, and have an override option. How human oversight is applied in practice will require vigorous discussion, learning and oversight
  • Data privacy in cross-border healthcare – Privacy of personal information, particularly health-related information, is an especially important boundary. The potential of artificial intelligence and its enabling technologies requires that the security of personal and, specifically, medical information be safeguarded. How that can and should be done is already hotly debated. There are technological solutions like blockchain, which can be applied
  • Bias – AI systems all contain bias. The degree of the bias will be amplified based on the words, images, and information on which the particular AI is ‘trained’. For so-called ‘narrow AI’ such as ChatGPT, Gemini (Google AI) or Perplexity, this bias may be less important. In the domain of medical information, the full spectrum of racial, ethnic or genetic differences among populations are not included in the training content of AI models, so this built-in bias can produce incorrect results. These built-in biases are especially dangerous in the next generation of artificial intelligence, generative AI, potentially creating even more distortions or ‘hallucinations’.

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The AI horizon

As constructive as these developments are, just on the horizon are further advances, such as the Internet of Things (IoT) and blockchain.

In IoT, appliances, sensors, rings, watches, eyeglasses, and even implantable devices all communicate with each other in ways that are seamlessly productive. As with so many other technological advances, ethical considerations and regulations are lagging. Powerful consumer interests and profit motivations continue to push IoT forward. Can your Oura Ring alert your cardiologist of an arrhythmia while you’re on vacation in France? Yes, it can. Do you want your insurance provider alerted? The answer is less clear.

Usually associated with cryptocurrency like Bitcoin, blockchain is a method of digitally confirming the authenticity of transactions and documents in a peer-to-peer computer environment. The method employed in blockchain can also authenticate and protect the security of claims and medical records. Its potential has not yet been explored in the medical travel and insurance markets. Wherever cybersecurity is a high priority, blockchain can be used to protect information.

An integrated future

Travel agencies, insurance companies, and healthcare providers will soon collaborate to use AI to protect travellers and to develop effective therapeutic treatments and regimens for health tourists. This level of integration necessitates systems interoperability and confidence that all the parties to the exchanges will protect confidential and proprietary information. For example, an airline’s fit-to-fly rules can interface with a hospital electronic medical record, signalling to the covered person and their insurance provider that it is safe for them to board a plane home.

Sensitive information needs protection, as do the AI-enabled processes used in the transaction. These require dual protection for the data, e.g. General Data Protection Regulation (GDPR) and Health Insurance Portability and Accountability Act (HIPAA) compliant personal data, as well as for the AI procedures used by the actors, some of whom will be competitors. As the race for technological advantage heats up, the competitive forces pushing these companies together will create frictions, leading to unlikely partnerships and mergers.

In IoT, appliances, sensors, rings, watches, eyeglasses, and even implantable devices all communicate with each other in ways that are seamlessly productive

Progress toward these AI-facilitated integrations requires trust, innovation, and entrepreneurship at a human level. For insurers, healthcare providers, and medical travellers, this AI-integrated future demands cooperation, mutually assured compliance and clear ethical guidelines. To realise the benefits of an AI-enabled future requires investment in talent, technology, and infrastructure. Regulatory considerations and industry standards need to be developed with insurers, providers, and consumers all at the table – including the robots!

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Case study 1: What a difference a few years makes

He could not believe his eyes when he saw how small the claims processing department had become. James was out of work for a few years, but Monica, his former boss at ABC Travel Insurance, was welcoming him back. She explained:

“The integration of AI-enabled technologies has really changed the landscape here in claims processing.” Monica asked James: “Remember how processing times used to be three to four weeks per claim, with error rates of 10–20%, all the paper shuffling for the adjusters and your team, and clients angry about delayed payments?” James winced and acknowledged. He remembered it all, and especially the VP worrying about fraudulent claims.

But today, the new system employs:

•   OCR and natural language processing (NLP) for

automated data extraction

•   Machine learning algorithms for pattern recognition

and fraud detection

•   AI-powered chatbots for customer support and claims status inquiries

•   Predictive analytics for claims approval likelihood

and payment forecasting.

Monica explained that the average claim processing time had dropped from 3.5 weeks to just 48 hours, with complex cases resolved within a week. And the error rate in claims processing had dropped from 10% to less than 2%, reducing the need for manual reviews and appeals. The AI system also identifies suspicious patterns, said Monica, “… with 95% accuracy!” Claims adjusters’ workload has been reduced by 60%, freeing up time for complex cases and strategic initiatives.

James said: “Customers must love that?”

Monica agreed: “Customer satisfaction scores improved by 35%.”

James smiled at what a difference a few years can make.

Case study 2: No beating around the bush

Layla had felt great until about an hour ago, just as the Land Rover left for the safari. She’d been so excited about this trip that she thought the sharp pain in her tummy was nerves.

After the pain became so bad she was unable to sit comfortably with her seatbelt on, she asked the driver to pull over; everyone was concerned and patient. The driver suggested taking Layla to a doctor in a village that was 30 minutes east. After 30 minutes passed and the pain was no better, Layla remembered she had received an SMS from her travel insurance before her trip. She clicked on a link in the message, and a web page opened, where she explained the situation in a few words.

In a single question, the conversational AI bot asked her to provide some more information. After her answer, it provided her with two recommendations: first, a referral to a trusted hospital, located one hour from her. Second, a link to start a call with a local doctor, in English. The doctor asked Layla about her symptoms, confirmed that she had to go to the nearest hospital, and provided her with some tips for the following hour. The driver was directed to the hospital, which was north, avoiding the wasted time travelling east, and possibly saving Layla’s life.

The appendectomy was successful, and Layla is already planning another safari.

For more information, please visit https://stackpoleassociates.com/

H&H February 2025

February 2025
 Issue

Offering readers a deep dive into the issues facing providers and payers of healthcare services around the world. Cost containment, international patient department development, the role of AI in healthcare delivery and more.

Read full issue

Irving Stackpole

Established in 1991, Stackpole & Associates is dedicated to measurably improving the relationships between and among providers, consumers, intermediaries and customers in the complex markets of healthcare, seniors housing, and care and human services. A team of specialised consultants provide premium, market-based solutions for organisations serving vulnerable populations.

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