Artificial Intelligence

Humana, IBM Partner To Streamline Member Engagement With AI

By Kelsey Waddill

– Humana has announced a partnership with IBM Watson Health that seeks to improve member engagement through artificial intelligence.

The solution will use an artificial intelligence-enabled virtual assistant to provide accurate benefits, costs, and provider information to agents, employers, and plan members.

The artificial intelligence-enabled virtual assistant will be connected to the IBM Watson Health cloud.

“At Humana, we strive to use technology to better serve our members with simple and convenient healthcare experiences,” said Chris Hunter, segment president of Humana’s group and military business.

“By harnessing the power of artificial intelligence fused with embedded analytics in the Watson Health platform, we can help our employer-customers, members, agents and broker partners enhance their knowledge so they can all make more informed decisions.”

The artificial intelligence-enabled virtual assistant aims to serve many roles. It could increase the accuracy and efficiency of member engagement and improve personalization. Artificial intelligence-enabled virtual assistants have also proven useful for redirecting callers with simple questions.

The payer may also leverage artificial intelligence to reduce members’ healthcare spending by helping them predict their healthcare costs. The tool would pull data from historical claims data and from provider data in order to present a personalized healthcare cost projection for members.

“Navigating our health coverage without the right support can potentially serve as a barrier to care,” said Paul Roma, general manager at IBM Watson Health.

“An AI-enabled conversational agent that is trained to understand health plan benefits logic can play a role in helping to simplify complex or possibly confusing plan information. We are proud to support Humana in leading the effort to deploy conversational AI to help enhance and improve the consumer experience.”

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The artificial intelligence solution will be available to Humana’s 1.3 million members in medical employer-sponsored health plans, as well as 1.8 million members in dental employer-sponsored health plans.

“Humana is excited to team up with IBM Watson Health to help our employer-customers and their employees better manage their healthcare benefits and costs through a more innovative, personalized experience,” Hunter said.

The movement toward storing healthcare data in the cloud has been characterized as a critical step in digitizing the healthcare system.

For example, when Providence St. Joseph Health was looking to partake in the digital transformation of the healthcare industry, it turned to Microsoft for cloud and artificial intelligence capabilities. At the time, Providence St. Joseph Health executives said that these tools would drive better clinical decision-making and unify the fractured health IT marketplace.

Additionally, payers have found various uses for artificial intelligence on the journey towards modernizing the healthcare system, uses that may improve member engagement, healthcare spending, and patient outcomes.

For example, in late 2020 Centene entered into an agreement to acquire Apixio Inc. The vendor’s artificial intelligence and technological tools were considered a key benefit to this merger. The payer stated that the artificial intelligence capabilities would enhance the company’s existing data analytics platform and accelerate value-based care.

Payers have also used artificial intelligence to identify potential commercial insurance fraud. Highmark was one of the first payers to use artificial intelligence to augment their analytics and catch fraud earlier. The payer’s tool can identify suspicious, potentially fraudulent patterns more quickly than humans can.

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Artificial intelligence is also becoming key for payer forecasting. However, payer experts have noted that this shift requires a new mindset around data analytics.

“It’s a new way of thinking,” Josh Goode, chief information officer at SCAN Health Plan, explained. “There is a little bit of change management as you work with your business users around how you approach doing machine learning artificial intelligence, versus building traditional analytics.”

Through their greater efficiency, these technologies are pushing forward payers’ real-time data analytics efforts and the modernization of the healthcare system as a whole.


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