• Artificial Intelligence Redefining the Health Insurance Industry

Artificial Intelligence Redefining the Health Insurance Industry

“Life is the sum of all your choices” (Albert Camus).

A well-known phrase that most of us can relate to, but have you ever put much thought to the impact today’s choices make on your tomorrow? Imagine you’re told that in 259 days you could potentially be diagnosed with a medical condition or chronic disease? And then imagine you’re told what actions can mitigate, or extend the prognosis of that condition? This is now a reality, and it will redefine the private health insurance space.

Artificial intelligence is now being used to predict the potential health journey of health fund members. Predictive analytics is allowing companies to develop a profile of a disease or chronic condition, five years before the onset of the condition. This profile considers age, gender, medical services used and the days between each medical service. This then enables us to compare individual member data to that profile. Those members exhibiting a similar journey can then begin preventative measures. Additionally, members can have their potential health journey mapped out. This mapping delivers potential medical services and expected days between each medical service. Each node is also given a weighting showing the likelihood of that medical service being in your journey.

This raises concern over what health funds intend to do with this information. Will health funds introduce new costing models that apply a premium to members with potential health problems? Health insurance costing is a complex issue, and the insight obtained from this analysis may impact costing in the future. It has been identified that 10% of health insurance members are responsible for 50% of all costs. It has also been said that at least 80% of all heart disease, type 2 diabetes and stroke can be prevented through lifestyle choices. Both these statistics then beg the question of who should be responsible for health costs if your lifestyle is impacting your health?

The answer to this question requires significant debate. And the focus of this article is on the positive impact these insights can deliver, and how the health industry can be redefined with such insights.

Lifestyle-related disease is on the rise. Obesity, sedentary lives and stress are contributing to a very unhealthy population – but small changes can make a big difference. For our obese population, losing 5% to 10% of body weight can deliver major benefits (Australian Government Preventative Health Taskforce). The Australian Government Preventative Health Taskforce reported the cost of obesity alone to be $8.3 billion (in 2008). The Taskforce stated that if more people were physically active for 30 minutes each day, it would save the healthcare system $1.5 billion per year. A study in the United States suggests savings to the economy of more than $30 billion per year can be achieved if overweight individuals reduce their caloric intake by 100 kcal per day (Dall et al, 2009).

Private health funds are aware of the cost of unhealthy lifestyles. Many health funds provide benefits to members who adopt a healthier lifestyle, such as discounted gym memberships. Whilst beneficial, these programs are generally suited to those who are aware of the benefits of physical activity. Where we will see real change is combining the predictive analytics with lifestyle data.

Health funds can lead the way in intervention and prevention programs and redefine the industry by introducing programs that make a real difference. When a health fund predicts a member’s journey, and provides tools to improve their health, the member is healthier and the health costs are less. The key is collecting the data to measure the impact. The data collected then defines the structure of future programs. This continuous loop of data collection and analysis then builds on the computational models already applied and generates further insights.

Private health funds have the potential to become enablers of healthy lifestyles. By analysing the impact of preventative measures, such as lifestyle and allied health services, health funds can create a healthier future. An initiative as simple as providing wearable devices to members allows personalised preventative programs, and a source of data collection.

The Eutopian future is a shift from reactive treatment to proactive prevention. Our private health funds can play a big part in this. The positive impact will transcend members and the funds – the impact will create healthier communities. Healthier communities create less demand on our healthcare system and a healthier economy. The power of data and artificial intelligence then delivers an improved future for everyone.


Dall, TM, Fulgoni, VL, Zhang, Y, Reimers, KJ, Packard, PT & Astwood JD, 2009, “Predicted national productivity implications of calorie and sodium reductions in the American diet”, American Journal of Health Promotion, Vol. 23, 6, pp. 423-430.

Australian Government Preventative Health Taskforce, The Benefits of Losing Weight, accessed March 2018.

Kylee Randall

Head of Consultancy & Special Projects

Kylee Randall has spent the last 17 years in roles focussed on developing high productivity, resilient cultures in corporations. She has successfully delivered complex projects that integrate technology and people. Kylee has witnessed the value wellbeing provides to organisations, striving to promote this mentality in all projects. Kylee’s qualifications include a business degree, Master of Business Administration (Sustainable Business) and she is currently studying a Post Graduate Diploma in IT.

#mentalillness in #Youth read how 21 friends supported youth mental health by running 21km.
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Looks like this would have been not only a great way to stay fit but awesome way to raise fund! Our GM in APAC, stomping the stadium!

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