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  • Sarah Devine

AI Revolutionizing Healthcare: Transforming Self-Funded Programs for Consultants

Updated: May 22


Artificial Intelligence Transforming Self-Funded Healthcare Programs

Artificial Intelligence (AI) has appeared recently as an innovative force across different industries and healthcare is no exception. With its ability to process vast amounts of data, show patterns, and make intelligent predictions, AI is transforming our daily routines in remarkable ways. It helps us find new recipes, organize our travel plans, and even craft a heartfelt thank-you note at the last minute.


For self-funded programs, AI-powered technologies offer consultants a new tool to navigate an already complex industry with ease. There are five ways in which AI will have a significant impact on consultants building self-funded programs.


1.) Cost Efficiency

Perhaps the biggest win for consultants is how AI can save money for their business and clients. AI algorithms can automate and streamline administrative tasks that used to take days or even weeks, allowing consultants to focus on selling and working more efficiently. For example, Novo Connection’s proprietary self-funded platform can quickly analyze years of claims data to forecast the best solutions for your unique group, identify any potential issues, and use predictive analytics and modeling for long-term savings.


2.) Customer Service

During the pandemic, the healthcare industry was strained across the board. The increased demand for healthcare services has led to increased innovation in AI and its role in servicing patients. Patients can slash their wait times by using chatbots to help answer questions.


However, AI is not a good replacement for complex cases. That’s why Novo Connection is dedicated to providing top-tier customer service to serve each client individually. We are able to dial up or down our service levels depending on the needs of our clients, so they pay only for what is needed. Our solutions involve real people, in real-time, advocating for clients in their healthcare journey.


3.) Enhanced Risk Management

For consultants managing self-funded insurance programs, risk management is of utmost importance. AI can help consultants assess and mitigate risks more effectively. By analyzing historical claims data and using predictive analytics, AI algorithms can find patterns and outliers, allowing consultants to proactively address potential risks – often before they know it’s a problem. For example, AI can flag individuals with chronic conditions who may require additional support or intervention, helping consultants design targeted wellness programs and preventive care strategies to minimize future claims.


4.) Pharmaceutical Analytics

One of the most promising applications of AI in self-funded programs is the potential to save thousands of dollars in pharmaceutical spending. Novo Connection can analyze each group’s unique claim’s data and gives consultants visible cost-savings solutions.


What Novo Connection can do:

  • Mine your claims data to find safe, low-cost alternative or generic prescriptions

  • Gain visibility into plan spend at the pharmacy, physician, participant, and individual claim level

  • Pinpoint key pricing discrepancies and find and implement solutions that most impact plan spend

  • Hold PBM’s accountable through our powerful analytics combined with program monitoring

  • Monitor plan performance and contractual guarantees

  • Find opportunities for contract negotiations


5.) Fully Integrating the Self-Funded Process

In the past, getting vetted vendors to work together and implementing a self-funded plan has been a challenge for consultants. Novo Connection is the only platform that can do everything from competitive stop-loss shopping to vendor selection and implementation.


The Novo Connection engine can:

  • Make early identifications of claims data to make intelligent recommendations that deliver immediate Rx and Medical savings (even before you know a problem exists)

  • Outreach to members and guide them to strategic cost-saving solutions

  • Build, implement, and service self-funded programs easily


The role of AI in healthcare is rapidly evolving and its impact on consultants building self-funded insurance programs is substantial. From streamlining administrative tasks to finding powerful cost-saving solutions, AI-powered technologies offer unprecedented opportunities for consultants to deliver more efficient, cost-effective, and precise self-funded programs. As more consultants look to technology-driven solutions, now is the time to embrace AI tools to stay ahead of the competition and remain relevant in a highly competitive market.


Novo Connection was designed with consultants in mind. By offering an end-to-end journey in the self-funded process, Novo Connection can step-in where consultants need help. Our services can be dialed-up or dialed-down dependent on the consultant's needs and can free up time that can be focused on winning more business.

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