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  • THE ROLE OF TECHNOLOGY AND AI WITHIN A PBM PARTNER

    As 2024 continues to unfold, conversations around new technologies abound. Specifically, artificial intelligence (AI) is one topic that often comes up in these conversations. AI is making impacts across a variety of industries, and that includes the insurance industry. Furthermore, insurance companies that partner with pharmacy benefit managers (PBMs) are likely to see AI-related technology adopted by many PBMs.

    For example, some PBMs rely heavily on technology, including AI. That might include using AI to assist with processing workers’ compensation or automobile no-fault claims, for example. Other PBMs may rely on AI to assist with data entry and other administrative processes.

    While technological advancements may bring a wealth of benefits to insurance companies, it is important to strike an appropriate balance between the rapid adoption of new, relatively untested technologies and providing a personalized touch. After all, even though AI systems can be beneficial, they are not completely flawless and can lead to errors and unintentionally biased outcomes.

    Northwood, an experienced durable medical equipment, prosthetics, orthotics and medical supplies (DMEPOS), pharmacy and ancillary service provider that acts as a PBM for multiple insurance companies, believes in the responsible use of technology. Northwood also prioritizes the human connection within its claims.

    As an example, Northwood embraces the benefits of technology through its claims system integration. In this case, leveraging technology allows Northwood to integrate with any insurance company’s claims platform. This eliminates a great many administrative burdens from examiners and adjusters since this integration allows Northwood to request and receive claim information from a company’s system seamlessly. This cuts back on delays within claims, ultimately making the entire process more efficient.

    On the other hand, Northwood also recognizes the importance of providing a personalized touch for claimants. It can be incredibly frustrating for claimants to navigate the generally complex world of claims administration because it is not something they are accustomed to dealing with regularly. When a company or a PBM relies too much on technology, that can exacerbate a claimant’s frustrations, which leads to lower claimant satisfaction scores.

    Another way Northwood offers a more personalized touch is via its customer care line. The staff members working with the customer care line are on hand to answer questions for claimants as well as adjusters and examiners. Often, a quick phone call with Northwood’s staff can assuage a claimant’s concerns and leave them feeling heard and cared for. This removes multiple frustration points for claimants, which is reflected in your insurance company’s claimant satisfaction scores. You will see this impact your retention rates as well, leading to an improved bottom line over time.

    When a PBM prioritizes a human touch over the use of technology, claimants have a better claim experience. Northwood is a trusted PBM that understands the importance of leveraging technology while keeping a personalized approach. For more information, please contact Rosanne Brugnoni at 586-755-3830 ext. 3771.

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