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Artificial Intelligence and Self-Funded Health Plans: Navigating the Claims Data Challenge

Healthcare - a sector that touches everyone - remains one of the most complex and convoluted systems worldwide. During this intricate web, self-funded health plans present a unique challenge. These employer-sponsored plans, offering greater flexibility and potential cost savings, often hit a brick wall regarding claims data. The current state of the market, dominated by insurance giants like Blue Cross, United Healthcare, Cigna, and Aetna - often referred to as the "Big Four" - makes it difficult for employers to access the claims information necessary for efficient plan underwriting. 

However, there's a silver lining on the horizon, and it's spelled EVHC and A-I.

The Challenge: Access to Claims Data

The claims data held by the Big Four is a treasure trove of information. This data, if accessible, could enable employers to optimize healthcare delivery and payment systems, resulting in better health outcomes for employees and potential cost savings. Unfortunately, this information is often inaccessible, posing a significant obstacle for employers trying to efficiently manage and underwrite their self-funded health plans.

The Solution: Artificial Intelligence 

Enter Artificial Intelligence (AI). AI is poised to revolutionize the way we approach health insurance. Through predictive modeling, machine learning, and data analytics, AI can provide an overview of healthcare trends, risks, and potential cost savings, even without complete claims data. This innovative approach can improve underwriting accuracy, proactive health management, and a healthier, more productive workforce.

However, for AI to work its magic, it requires large and diverse data sets. The current data monopoly by the Big Four presents a significant challenge, but one that the AI community is equipped and eager to overcome. 

Your Role in This Revolution

The transformative potential of AI in healthcare is enormous, but it cannot be realized without active engagement from various stakeholders. 
This is where you come in.

Whether you're a healthcare professional, an employer, an AI enthusiast, or someone who believes in a better, more transparent healthcare system, we invite you to join us in making a difference.

Here's what you can do:

  1. Start Conversations: Use your platform to talk about the potential of AI in healthcare. Discuss the challenges of the current insurance market, the importance of claims data, and the transformative potential of AI.
  2. Advocate for Transparency: Reach out to your insurance providers. Encourage them to share claims data and be a part of the solution rather than part of the problem.
  3. Connect with Us: At, we are committed to driving this revolution. We'd love to hear from you if you're interested in learning more, partnering with us, or investing in this cause.

The intersection of AI and healthcare presents an incredible opportunity to reimagine and reinvent the industry. Let's seize this opportunity and work together to create a healthier future.

The AI revolution in healthcare is here. Are you ready to be a part of it? Join EVHC, and let's reshape healthcare together!


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