Unreliable provider data is preventing many U.S. health plans from maximizing the value of artificial intelligence.
Eighty-five percent of health plan leaders struggle with provider data inaccuracies, with an average of 19% of their data considered unreliable, a new report from Kyruus Health found. As a result, more than three-quarters of plan are forced to perform manual data updates "all the time" or "often," consuming resources that could be directed toward innovation.
"This research exposes a foundational crisis in health care,” said Morgan Beschle, the company’s vice president of product. “Health plans have a massive opportunity to guide members to high-quality, cost-effective care, but they are building on a house of cards if their provider data is inaccurate, incomplete and lacks the critical information members need to shop for and select care.”
The research, based on a survey of 100 senior leaders at U.S. health plans, found that although 100% of executives believe AI will be critical to their network strategy within a year, inaccurate provider data is a primary obstacle to progress. The research highlights a critical disconnect. Although plans aim to reduce medical spending (45%) and support value-based care (44%), they are hindered by internal barriers. Nearly half of the leaders surveyed cited resistance to change (47%) and the lack of a clear strategy (46%) as the biggest obstacles to implementing an effective member steerage and navigation strategy.
Among other highlights of the report:
- AI paradox Although all health plan executives agree AI is essential for the future, only 16% report using it widely for member guidance today.
- Foundational focus. Health plan leaders are prioritizing foundational improvements over advanced tools. Improving provider data accuracy ranks as the top investment priority (26%) for member guidance, ahead of implementing more-advanced AI (14%).
- Top priorities. The leading drivers for implementing a steerage strategy are reducing medical spend while maintaining quality (45%); supporting value-based care arrangements (44%); and enhancing the member experience (42%).
"To truly create the seamless experience members expect, leaders must first focus on transforming their data foundation and the information members need to select the right care,” Beschle said. “Only then can they bridge the gap between plan capabilities and member needs, and harness powerful tools like AI."
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