Oscar Health Leverages OpenAI to Revolutionize Healthcare Processes

Oscar Health, a leading healthcare technology company, has announced significant advancements from its collaboration with OpenAI. Notably, Oscar Health is the first insurance company to sign a Business Associate Agreement (BAA) with OpenAI.
ChatGPT from OpenAI“We benchmark all the major models on a regular basis, with proprietary datasets for healthcare-specific use cases. The OpenAI models consistently perform the best,” Nikhita Luthra, Senior Product Manager and AI R&D Lead at Oscar, said.

The integration of AI solutions from OpenAI has enabled Oscar Health to streamline and automate labor-intensive processes, significantly reducing healthcare costs. Key achievements include:

Improved Documentation Efficiency: Documenting a single conversation between a patient and the medical team typically takes over 20 minutes. With OpenAI’s API, Oscar has cut this time by nearly 40 percent. Research and development indicate that GPT-4 can increase productivity by up to 90 percent in certain scenarios.

Enhanced Claims Processing: Oscar has developed an AI assistant using OpenAI’s API to navigate detailed claim logs. This assistant efficiently automates the process of answering questions about patient claims.

As a result, the time required for the claims processing team to resolve escalations has been halved, achieving accuracy on par with, or exceeding, human agents. Oscar projects the automation of investigations for at least 4,000 tickets per month, totaling 48,000 tickets by the end of the year.

Additionally, for patients with complex and acute health situations requiring extensive medical records — sometimes up to 500 pages — Oscar is unlocking significant potential by leveraging OpenAI’s capabilities.

“The biggest takeaway has been that the regulators in healthcare want AI to succeed, and they’re incredibly excited,” Mario Schlosser, Co-Founder and Chief Technology Officer of Oscar, said.

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