Description
The session is envisioned as a space wherein countries can share about their digital initiatives in managing health insurance schemes and the practical challenges that come with it. It will feature artificial intelligence (AI) as a potential tool for addressing some of these challenges - exploring the aspects AI can and cannot solve in the health insurance sector.
Contributors
Joint Learning Network/World Bank: Pak Somil Nagpal (Lead Health Specialist) and Pak Pandu Harimurti (Senior Health Specialist)
BPJS: Mr. Donni Hendrawan (Deputy Director of Data Management and Information), Mr. Jusron (Data Analytics Head)
openIMIS Initiative: Saurav Bhattarai (Advisor and openIMIS Team Lead)
GIZ: Karlina Octaviany (AI Specialist, FAIR Forward)
Objectives
Discuss country challenges in digitizing health insurance management
Describe BPJS’ experience in adopting AI for health insurance
Explain how AI works in conjunction with existing insurance management information systems
Critique the role of AI in the health insurance sector
Agenda
GIZ Indonesia: Session orientation / faciliation (3-5 min)
JLN/WB: “Examples of Applied AI in Health Insurance” (15-20 min)
● Collection of concrete examples (e.g. fraud detection)
● Conclusions on long-term perspective and risks (reference to digital health report)
BPJS: “Experiences of BPJS-K on Data Analytics: From Data Governance to AI” (15-20 min)
● Personal data protection
● Implementation for fraud management (claims verification)
openIMIS Initiative: “Opportunities of AI in Health Insurance” (15-20 min)
● Examples of AI claims adjudication (AI module in openIMIS)
Discussion and Open Forum (50 min)