Creating Value for Healthcare Payers and Customers With Conversational AI

By Sarah Mason, Staff Writer
October 19, 2021 • 4 minute read

Healthcare plans are flush with capital following the pandemic — and payers should make investment in Conversational AI solutions a priority.

The healthcare industry leaned heavily into digital channels to keep its ecosystems running during the global pandemic. Physicians and patients stayed connected through virtual care tools, and many healthcare companies deployed AI to screen for COVID-19 symptoms, among other tasks. For many healthcare organizations, digital transformation aspirations were realized far sooner than expected, and further developments are on the horizon.

In a recent survey conducted by PwC, they found that healthcare plans are currently well stocked with capital, due to high levels of deferred care during the pandemic. PwC’s Health Research Institute anticipates that healthcare companies will invest this capital in tools and strategies that will “position them for growth.”

Like most healthcare organizations, healthcare payers have high digital aspirations, and many are simply looking for the right tools to invest in. With their sights set on improving member experience, and driving current and future growth, healthcare payers should invest in Conversational AI.

Improving Members’ Digital Experiences with Conversational AI

Pandemic-related restrictions squeezed almost every aspect of daily life into virtual portals. In the blink of an eye, more people began depositing checks through mobile apps, ordering groceries and home décor online and talking to family doctors via video calls — because they had little choice. As a result, these digital experiences became familiar, to the point where people now have come to expect seamless, intuitive digital experiences across all industries.

Even as pandemic restrictions ease and people return to in-person activities, it’s clear that the pandemic has left a lasting impression on peoples’ expectations for digital experiences, including healthcare. Within the healthcare industry, one of this year’s top eight patient experience trends is a desire for more streamlined patient experiences, enabled by digital tools, as recently highlighted in Forbes. McKinsey also found that healthcare payers with business models that “incorporate care delivery and advanced analytics to better serve individuals” generate excellent returns.

This clearly suggests that as old perception of service and care fade, there is high demand for digitally enabled member experiences, which is why healthcare payers should look to invest in tools that deliver superior service such as Conversational AI.

While chatbots and outdated IVR systems cause more confusion than clarity, Conversational AI agents deliver personalized, human-like support at AI speed and scale. Conversational AI agents such as Amelia also integrate with healthcare systems and tools in order to provide members with up-to-date information on their healthcare coverage, claims payment status and more.

For example, if a member wants to know how much coverage they have left for dental care, instead of navigating complicated portals on their own time, or waiting on hold for a payer agent to answer their call, members can speak directly to Amelia for an immediate answer. If the member then decides to change their coverage, they can make this request in the same interaction with Amelia.

As noted above, before the pandemic there was very little urgency behind the healthcare industry’s drive toward digital transformation. However, as the industry emerges from the pandemic, and digital healthcare experiences remain prominent, payers are taking note.

PwC’s Health Research Institute found that almost half of all payer executives surveyed in their research were investing in “digital product support and educational tools” in order to improve their member experiences. If healthcare payers want to match their digitally inclined members’ expectations, they must invest in technologies like Conversational AI to create better member experiences, and to remain competitive and viable.

How Conversational AI Can Help Build a Healthier Future

Many members deferred care and medical procedures during the past two years, creating an entirely new set of problems for both members and payers. Ogilvy Consulting spoke with leaders in payer innovation and determined that healthcare payers are becoming increasingly concerned about their members’ worsening health conditions due to the mass interruption of procedures, as well as members’ reluctance to visit doctors for routine check-ups and risk COVID exposure.

Going forward, healthcare payers can expect higher demands for more personalized, complex support as members return to regular health check-ups and procedures, particularly by utilizing digital channels. To prepare for the near- and long-term effects of deferred care, payers should invest now in tools that will bolster their digital member experiences.

As member requests through digital channels spike in volume, Conversational AI agents like Amelia can scale to match the demand while conducting highly personalized, human-like conversations with every member. Payers also can ensure they’re well-prepared to manage and maintain high service levels and relieve overwhelmed human agents struggling to keep up with higher demand.

In addition, EY notes that insurance customers are not as connected with their providers as they are with other companies, and show a willingness to change providers if they experience poor customer service or uncompetitive pricing. As the industry faces an influx of members looking to better manage their health post-pandemic, as well as those with worsened health conditions brought on by delayed care or chronic illnesses (such as potentially long-haul COVID recovery), it’s now critical for healthcare payers to strengthen member relationships in order to support their care plans and improve their overall wellbeing.

For instance, PwC encourages healthcare payers to invest in digital tools to foster more continuous member care. Unlike basic chatbots, Conversational AI is a solution that can act as a personal healthcare assistant for individual members, providing real-time coverage updates and personalized reminders to encourage members to actively engage with their care plans.

Healthcare payers are poised to invest and grow, members want better services through robust digital channels, and the industry seems destined to face an influx of members with delayed-care needs and potentially worsening health conditions. A critical underpinning for healthcare payers to address all of these trends is deploying Conversational AI for better, personalized and more efficient member services.

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