Promises and Perils of AI – Part 17: AI in Member/Patient Retention: Building Loyalty in Healthcare

This week I explore the question: How can AI help providers and payers retain patients and members in a competitive healthcare environment?

Retention is a critical focus for both providers and payers as healthcare becomes more consumer-driven. AI enhances retention efforts by enabling personalized engagement, identifying churn risks, and improving overall experiences.

Provider Side: For providers, AI personalizes patient interactions to foster loyalty. Predictive analytics identify patients who are due for check-ups, screenings, or follow-ups and send tailored reminders. For instance, a patient with diabetes might receive outreach about managing blood sugar levels through educational resources or support groups. The outreach can be personalized in a way that fully engages the hearts and minds of patients, so they can achieve the health outcomes that are most meaningful to them.

AI tools also improve the patient experience. Chatbots and virtual assistants can address queries 24/7, minimizing wait times and improving satisfaction. Sentiment analysis from patient surveys helps providers proactively address complaints or areas for improvement.

In addition, AI identifies patients likely to switch providers or miss appointments, allowing staff to engage with these individuals and address their concerns before they leave. From a cost and quality standpoint, missed appointments like infusion therapy are particularly important, as other patients could really use the appointment slot and expensive and scarce drugs are sometimes mixed ahead of time. Keeping or reallocating those appointments allow better access and ensures drugs aren’t wasted.

Payer Side: Payers use AI to predict member churn by analyzing patterns such as changes in claim submissions, decreased portal activity, or negative feedback. AI can use the longitudinal patient record and are able to identify patterns that may not be readily apparent to humans. These insights help payers proactively engage members through targeted interventions, such as personalized wellness programs, and financial incentives.

AI also enhances the member experience by simplifying processes like benefit selection during open enrollment, claims tracking, and provider searches. Virtual assistants can guide members through complex tasks, and perhaps one day, AI agents will be able to perform the tasks for them, further increasing satisfaction and loyalty.

Moreover, AI helps payers design competitive and meaningful health plans. By analyzing member preferences and market trends, payers can create offerings that attract and retain members, delighting them in an otherwise crowded and competitive marketplace.

Next Steps/Recommendations:

1. For providers: Use AI to identify and address factors driving patient dissatisfaction or attrition.

2. For payers: Leverage AI to design tailored plans and member engagement strategies that foster loyalty.

3. Encourage partnerships that align payer and provider retention strategies for seamless care experiences. Combining payer, provide and other consumer data provides some of the biggest opportunities for personalized care and coverage.

Philosophical Question to Ponder in Closing:

As AI personalizes retention strategies, how do we ensure the level of personalization doesn’t feel creepy, and also ensure fairness and inclusivity in addressing the needs of diverse patient and member populations?

Disclaimer: The views and opinions expressed in this post are solely my own and do not necessarily reflect the views or positions of my employer or any affiliated organizations.