Navigating the future of health care

With the COVID-19 pandemic exposing the struggles that our national health-care system is facing, there has been a growing emphasis on improving health-care navigation for Canadians.  

Further, as governments work to overcome health-care gaps and challenges – such as staff shortages – people in Canada are becoming more engaged in their own well-being. Employers are also proactively keeping their workforces healthy by adding more health benefits like digital health solutions, which, amid rising labour shortages, burnout, and disengagement, are helping to attract and retain top talent.  

While this proactive approach by employers to add vetted health resources is a good step, the call for easier accessibility and navigation of these resources is expected to increase as more Generation Zs (or Gen Z) join the workforce. According to a paper by TELUS Health, Gen Z is facing a mental health crisis, and they have a strong preference for personalized services, expecting personalization and technology to be integrated into all areas of their workplace. In fact, the same paper highlighted how 91 percent of Gen Z workers said that the technologies offered by an employer are a factor in deciding among similar job offers. As this trend emerges, private payers see an opportunity to lead in bringing these innovative solutions to the marketplace at scale. 

Payers and employers can further improve these solutions by using innovative Artificial Intelligence (AI) to strengthen relationships with employees and plan members while creating cost sustainability for benefits payers, employers, and plan members. 

AI-strengthened relationships as a competitive advantage  

Innovation in health navigation calls for a fresh approach from employers and payers to keep them competitive, as younger employees, in particular, have less patience wading through a myriad of health resources and manual inputs that make up many companies’ health programs. 

AI and personalization may appear contradictory to some, but recent developments in the market show how advanced AI-powered health navigation experiences can deliver more customizable solutions that meet the needs and expectations of plan members and their dependents.  

How could this work? Let’s imagine you sprained your ankle while playing soccer. When accessing the care provider registry selected by your employer, you can quickly access a network of practitioners near you who are vetted by your insurer and covered by your group benefit plan. This eliminates time-consuming searches and makes it faster and easier for you to receive care while processing your claim adjudication and reimbursement in real time. 

Now consider a scenario where a plan member is suffering from mental stress and doesn’t have access to these tools. They have little energy to browse manually through multiple webpages to find a suitable professional who aligns with their preferences, has been vetted by the insurer, and is covered under their plan. They may not, in fact, get connected with the care they need or that is covered by their benefit plan. With an advanced, smart health-navigation system, the care provider registry can understand the plan members’ needs and connect them with trusted resources within their benefit ecosystem, including their employer’s employee assistance plan (EAP) as a preferred partner. This process makes it more convenient for plan members to access the support they need for their mental well-being. 

The convergence between payers and providers as an enabler of better health outcomes

The above examples illustrate how AI serves as the catalyst for connecting health records, claims, and provider networks, resulting in personalized and efficient services for end users. By moving through a more seamless health-care navigation journey, one’s health outcomes are improved and engagement is heightened.

On the payer side, leveraging AI algorithms that analyze patterns can accurately detect fraudulent claims. By enabling the allocation of resources to legitimate claims, AI algorithms ensure resources are used efficiently so that they can be dedicated to creating competitive plans that help to retain talent. By slashing the amount of administrative burden and manual inputs needed, these algorithms also encourage cost sustainability. 

Canadians are increasingly empowering themselves to make informed decisions about their health and well-being, but are also expecting their employers to play a bigger role. By prioritizing personalization, access, and improved user experience in health navigation through AI, payers and employers can not only rise to the challenge but also remain competitive in the effort to recruit and keep the best talent. 

Martin Bélanger is managing director, payor and provider solutions, TELUS Health