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The healthcare industry is too complex, costly, and cumbersome. Since our inception, we have been at the forefront of using innovative technologies and leveraging our tech stack to simplify the insurance process and improve member outcomes.

Our team recently worked with OpenAI on a case study analyzing Oscar's use of AI across our business — and our opportunity to improve healthcare. We found success within the following use cases:

1. Clinical documentation

2. Building a claims assistant

3. AI’s impact on medical record data

Improving the Clinical Documentation Process

Documenting a single conversation between a patient and the medical team can take a human more than 20 minutes. With OpenAI’s API, we have cut the time spent documenting medical care conversations and reviewing lab test results by nearly 40%, saving countless hours and less tangibly, reducing provider burnout by allowing nurses and clinicians to focus on higher-order tasks.  

How We’re Navigating Claims More Efficiently

Understanding the life story of a claim is incredibly complex work, as there are millions of contractual variables at play. When a doctor has a question about a claim, our teams must navigate detailed logs of every decision made throughout a claim’s processing journey. With OpenAI’s API, we have built an assistant that navigates the claim trace efficiently and helps us automate aspects of the claim investigation process.

The claims assistant has reduced the time it takes for the claims processing team to resolve escalations by 50%, with accuracy on par or better than human agents. We expect to automate investigation for at least 4,000 tickets per month, or 48,000 tickets by the end of the year.

Unlocking Unstructured Medical Records

Medical records contain critical patient information and are used across the healthcare ecosystem, but they’re written in highly unstructured and messy natural language. For patients with the most complex and acute health situations, they can be as long as 500 pages. Finding a relevant piece of information in a medical record is like finding a needle in a haystack.

In working with OpenAI, there is potential to unlock powerful use cases with medical records that were previously untenable, such as: 

Summarizing a patient's medical record to ensure a personalized and efficient visit with a provider 

Analyzing medical records to answer questions like, "Which diabetic patients are a good fit for continuous glucose monitoring?"

Nikhita Luthra, Oscar’s Senior Product Manager and AI Research and Development Lead highlights the significance of these advancements: “There’s a bias in the system where the patients with the most acute and complex healthcare situations are the ones with the longest medical records that are the most cumbersome to query, analyze, and summarize…now we have a way to make sure that the sickest patients have access to the best care possible, just like everybody else.” 

We're encouraged by the early results of our AI implementations and look forward to further unlocking its potential in healthcare. For more insights into our utilization of OpenAI to enhance the healthcare experience, watch the video below.