Reducing health insurance costs and improving care

Oscar has used AI to speed up and automate tedious manual processes that drive up healthcare costs. They found success with the following use cases:

Clinical documentation. Documenting a single conversation between a patient and the medical team can take a human more than 20 minutes. With OpenAI’s API, Oscar has cut the time spent documenting medical care conversations and reviewing lab test results by nearly 40%, saving countless hours across the company and less tangibly, reducing burnout by allowing nurses and clinicians to focus on higher-order tasks. This is just the beginning—R&D shows that GPT‑4 can get productivity gains up to 90% in some cases.

Building a claims assistant. 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, Oscar’s teams must navigate detailed logs of every decision made throughout a claim’s processing journey. With OpenAI’s API, Oscar has built an assistant that navigates the claim trace efficiently and automates the process of answering questions about the patient’s claims.

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. Oscar expects to automate investigation for at least 4,000 tickets per month, or 48,000 tickets by the end of the year.