AI has saved it billions, healthcare group AfroCentric says

Healthcare group AfroCentric says it has been able to save billions in administration costs for its business by deploying artificial intelligence (AI) in its operations.

The group is hoping to introduce systems that will allow policy holders to better understand what coverage they have using the same technology powering the ChatGPT platform. 

AI investment, or at least its visibility, has grown in leaps and bounds in 2023, driven by the rapid adoption and popularity of OpenAI’s ChatGPT since launching in November 2022. 

ChatGPT is a chatbot underpinned by a large language model, launched by AI nonprofit OpenAI. It is capable of generating human-like text and has a range of applications, including translation.

Vukosi Sambo, head of data and insights at AfroCentric said the use of AI has given the group a number of financial wins but warned that implementation of such systems is complex and has to be approached prudently, advocating for a layered approach.

AfroCentric owns SA’s second-biggest medical scheme administrator, Medscheme, and provides healthcare products and services to the public and private healthcare sectors.

“We deal with 12.5-million claim lines that we process every month. Over 99% of those go straight through without being touched by a human being ... it is AI in its classical sense.”

Strategy link

Sambo says the group has also applied the technology in dealing with fraud and abuse cases, “where we are able to save our scheme clients over R150m annually”.

While the technology is powerful, it does need to be linked to an organisation’s strategy as a second layer, he said.

As a way to keep customers happy, AfroCentric works to increase value for its base, at least to be seen as a company working to drive down costs for customers.

AfroCentric recently reported marginal membership growth in the interim period to March.

The company has long been vocal about stagnant medical scheme membership and that far more urgency is needed to change laws to allow for lower-cost alternatives. AI is being used in this effort. 

“By understanding the patterns of consumptions and how you are consuming your healthcare, we are able to navigate and manage your risk better in a way that is saving our scheme clients R4.6bn,” Sambo said. 

That translates to an average of R241 per month for each policy holder. “That goes a long way in the current economy and conditions for our kind of market,” he said. 

The group is working on a platform that would help customers to better understand the structure and nature of the care they are paying for. People do not understand medical products as much as they think they do until they have to use the products or make a claim, Sambo said. 

Social factors or context also have to be considered. “We don’t want systems that are biased or discriminate on the basis of race, gender [and] religious affiliation.”

The use of AI has been a minefield for some businesses. 

In late 2022, US-based technology media outlet CNET started publishing articles generated by an AI system on topics such as personal finance that were riddled with mistakes. Since then, its staff have made efforts to unionise, calling for better working conditions, as well as greater accountability regarding the use of AI.

Given AfroCentric's place in SA’s healthcare market, with over 3-million policies on its books, mistakes could have grave consequences. 

“We are using this already powerfully tool and would like to see ourselves as one of the organisations that have adopted AI with purpose and seeing the great outcomes of it. There is obviously room for greater improvement,” Sambo said. 

• In May, the Sanlam Group obtained a controlling stake in Afrocentric, valued at about R3.3bn on the JSE that will allow it to add a healthcare offering to its existing suite of financial products spanning investments, insurance, retirement, financial planning and wealth management.

gavazam@businesslive.co.za