Expion Health revamps its RFP process with AI

And with just six underwriters on staff, Expion could respond to only about 200 RFPs per year, limiting the company’s ability to bring in new business.

Machine decisions

In August 2023, the Expion IT team, with support from executive leadership, launched an internal project to automate the complex underwriting process for prescription cost management.

In about six months, Expion’s two AI developers created ExpionIQ Advisor, a tool that uses linear regression, multiple algorithms, and custom-built AI models to automate prescription RFPs. The IT team plans to further enhance the application using the XGBoost machine learning software library for forecasting medication use in covered populations.

ExpionIQ Advisor has cut the time to calculate the numbers needed for an RFP to a few hours, instead of days, Kumar says. The new application also allows employees to check its work, he adds.

“Now I know exactly what math we are using and what risk are we taking, and even if the model is predicting something wrong, we know exactly what to do to go fix that issue,” Kumar says. “In the past, anybody could make a mistake easily. Now, if the model is drifting away, we get alerted automatically, and we fix it.”

A web-based .NET application on the front end of ExpionIQ Advisor allows underwriters and other users to log in to the system and check the numbers. “The .NET application brings it all together and does the final computation to present that data in an easy-to-digest manner as well as provide a printout to our end customers,” Kumar says.