Becker’s Payer Issues Podcast Leveraging AI and Predictive Models to Improve Member Experience: Insights from Humana and Everise
May 21, 2025
Sadie Rizzuto, VP at Humana, focuses on improving health outcomes for Medicare and Medicaid, while Stuart Langley, SVP at Everise, specializes in healthcare BPO services. They delve into the transformative power of AI and predictive models in enhancing member engagement. The discussion highlights how technology can streamline the claims process, improve appointment scheduling, and foster proactive care. They emphasize the importance of understanding member needs while navigating the complexities of AI integration, urging a focus on real-world needs over mere tech trends.
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Episode notes
Predictive Models Enhance Member Engagement
- Predictive models help meet members where they are, focusing on quality over quantity of interactions.
- They identify barriers like social determinants impacting medication adherence to tailor outreach effectively.
App Simplifies Stressful Claims Process
- Members facing claims processes are already stressed, so simplifying steps through apps reduces friction.
- Allowing direct scheduling through apps eases the navigation of care during difficult times.
Leverage Data Automation with Providers
- Use intelligent data automation to reduce friction between payers and providers.
- Smoothing provider interactions digitally benefits members by improving payment reconciliation and access.