Lately, my colleagues and I have been fielding a lot of questions about artificial intelligence from health-insurance executives. Could AI power chatbots that answer members’ questions about anything from doctors to deductibles to dieting – reducing their call-center costs?
The answer: it could – but only if they first set up their data to enable these technologies. And more importantly, if they shift from thinking about customer experience purely as a cost driver. By bringing a new level of organization and sophistications to their data operations, payers can transform customer experience and unlock a new source of growth and profitability.
The goal
The ultimate goal is to transform patient experience: members start chat sessions on computers or mobile devices, machine learning understands their simple questions and complex concerns and dishes up quick answers and, better yet, suggestions for next-best actions that put them on a path toward healthier and less expensive outcomes. That doesn’t mean replacing the contact center, which will likely always be the preferred avenue for many customer questions. Instead it means creating a more agile operation that gives members choices and uses resources more efficiently.
But no AI program can work that magic with the way most payers’ data is currently organized. Even highly trained employees sometimes have trouble resolving these questions because the data is scattered among unconnected systems.
Here’s how bad data deficiencies can get. I heard recently about a member who called customer service for a large West Coast insurer seeking the costs for procedures with specific codes; the member was bumped to different departments for weeks. Eventually the plan determined that giving an accurate answer was impossible with its current system. The member was furious, and word of her experience went all the way to the CEO.
Capturing all the data
To avoid experiences like that, insurers need to start by capturing data from all customer interactions with call centers, member portals and mobile apps. Once they pull together that information, they can use technology to identify the questions any individual customer is most likely to ask and build a solid understanding of how every inquiry is likely to go.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
I’m talking about gathering deep intelligence – mostly uncollected and lost now – about customer experience that goes beyond breaking interactions into course-grained topics, such as benefits inquiries, claims status or in-network doctor searches.
When members’ inquiries are linked with their demographic information, care histories, plan information and hundreds of other data points, artificial intelligence can, using predictive models and human language processing, anticipate their next questions and help with their most pressing health concerns.
Consider an example of a diabetic member with obesity who has completed a handful of chiropractic visits. When she starts a chat session, she sees the dialog box where she can enter a question, but payers also could seed the bot to offer a few questions that the woman could choose. One might be, “Are you interested in learning about healthy meal planning for diabetics?”
If the woman starts typing a question with the phrase “chiropractic visits,” that could trigger a response like, “Would you like to know how many more chiropractic visits your plan will cover?” Technology called a microservice would use her member ID to return the number of visits.
It’s worth noting here that the same level of data management and analysis would improve the call-center experience as well. Rather than fielding a member’s question and going spelunking through multiple databases and systems in search of an answer, reps would be able to seek and find what they’re looking for through a single interface on a single screen.
Those kinds of customer experiences will help drive members toward better health outcomes – and drive lower costs and higher profits for their plans. They will also help engender customer loyalty and create differentiation for plans in a competitive market.
That’s the promise of AI. But it can’t be fulfilled unless health plans first start using tools that collect details from exchanges with customers.
Toward better, more effectual customer interactions
The good news: Artificial intelligence has the power to revolutionize health insurance customer service in a way that could dramatically lower costs and improve the quality and efficiency of healthcare. The technology exists, and we’ve seen solutions like chatbots create better, more effectual customer interactions across plenty of other industries.
Consumers will expect same kind of digital experience they have with other businesses that already deploy chatbots to recommend outfits to go with a shirt, songs like the ones they listen to most or recipes that combine the groceries in their cart. And don’t forget that many people have become comfortable talking to personal assistant bots in their homes to manage to-do lists and schedule appointments.
If payers want to use the technology that would allow customers to make use of online portals for much more than electronic health records, new ID card requests and provider searches, they should start by addressing their data shortcomings now with new tracking and analysis tools.
Consumers will be empowered to lower the cost of healthcare when their insurers give them the information and tools they need to use their benefits more effectively. They’ll also be more likely to seek and stay enrolled with carriers who offer that information and those tools – as will their employers. And those carriers will unlock a new growth center for their businesses: customer experience.
Photo: venimo, Getty Images
