3 Ways AI Improves the Health Insurance Experience

From helping customers choose the right plan to maximizing Medicare Star ratings, AI is set to transform the health insurance industry.

If there’s one certainty in the uncertain world of health insurance, it’s that artificial intelligence will play an increasingly important role in maximizing outcomes, efficiency and satisfaction. That outlook is based on what we at Nuance are hearing every week from payers across the country, big and small.

Take virtual assistants, which most people now use every day on their mobile phones. These devices have conditioned users to converse with a computer as naturally as they might with a human agent. Meanwhile, continued advances in speech recognition and other technologies enable virtual assistants to understand everyday language, including slang, instead of forcing people to know and use a limited set of industry-specific terms.

Check out these three ways that virtual assistants and other capabilities that leverage artificial intelligence have begun transforming consumer interactions within health insurance.

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1. Helping Customers Choose the Right Plan

When it comes to customer service, research shows that for nearly every demographic and industry, not just insurance, consumers overwhelmingly prefer self-service to talking with a live agent. But self-service typically requires that consumers slog through FAQs and other online collateral — exactly what consumers say they don’t want. In a 2016 survey by research firm AYTM, 89 percent of consumers worldwide said they want to use a virtual agent to get information instead of searching through a company’s website or mobile app.

That preference is good news for plans exploring more efficient and effective ways to engage shoppers and switchers.

How efficient? One top-five plan deployed a virtual assistant on its PC and mobile websites, where it has achieved 77 percent first-contact resolution. The virtual assistant helps to save money by reducing the staff necessary at the contact center and frees live agents to provide white-glove service to people with complex inquiries. No wonder so many plans are implementing virtual assistants.

Moreover, when they’re deployed in phone channels — the interactive voice response (IVR) system and/or mobile app — virtual assistants can be paired with voice biometrics to eliminate another pain point: remembering PINs and passwords.

The human voice is as unique as a fingerprint, which is why so many banks and other businesses are using voice biometrics to authenticate customers. The AYTM survey found that 83 percent of consumers prefer alternatives like voice biometrics, making the technology something that plans should consider for authentication. It also means contact center agents spend less time fielding member portal password resets, which frees them to focus on other customer needs.

2. Managing Chronic Conditions More Effectively

Plans know that biometric data is key for better managing chronic conditions, but collecting it is not the best use of time for nurses and other skilled staff. Advances in technology now enable more of that data to be collected through self-service or directly by patients, such as with wearables and in-home devices.

Virtual agents play a role by, for example, fielding patient inquiries about the readings. The agents can analyze the readings to determine whether they can answer the patient’s question or they need to escalate it to a human, such as a care manager or physician.

In the past year, I’ve seen multiple plans begin implementing these kinds of self-service capabilities.

3. Proactive Engagement Boosts Medicare Star Ratings

Medicare Star ratings performance is among the factors most strongly correlated with enrollment increases. There’s an enormous opportunity for plans to use text messages, automated voice calls and emails to cost-effectively boost compliance, such as for diabetic eye and foot exams, mammograms and more.

Tip: Choose a platform that can create and issue these alerts across multiple channels, instead of separate platforms for email, voice and so on. An advanced platform should be able to not only act on explicit member preferences, but glean implicit preferences from member actions, such as best time or day to reach them.

It’s another year of change and uncertainty for the health plan industry. The good news for plans and consumers alike is that artificial intelligence is a proven way to maximize outcomes, satisfaction and savings. That’s a future we all can look forward to.

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Sep 05 2017