Quick guide for health insurers
For health insurers, the challenges presented by the pandemic exacerbated many of the industry’s pre-existing conditions around member satisfaction and escalating costs:
Fortunately, these problems aren’t incurable. Recent advances in conversational artificial intelligence (AI) are proving highly effective in helping insurers overcome the challenges around member experience, while AI-powered automation applies intelligent analytics to address the claims overpayment problem.
This ebook covers four “treatments” that use conversational AI, automation, and other advanced technologies to deliver a positive, frictionless experience for members and agents while reducing costs.
“83% of healthcare organizations have implemented an artificial intelligence strategy, while another 15% are planning to develop one”
Source: “Third Annual Optum Survey on AI in Health Care,” Optum, October 2020.
Driving strategic outcomes for health insurers
Using conversational AI and automation, health insurers can:
Improve member experience, satisfaction and loyalty
Increase contact center efficiency and scalability
Catch overpayment before it happens
Improve agent experience, satisfaction, and retention
Source: “Why Contact Centers Are a Key Part of a Human+Digital Banking Strategy,”
Kevin Halsey, The Financial Brand, December 2020
Apply Conversational AI to Member Self-Service
Improving the member experience starts by understanding and optimizing every conversation before, during, and after an agent/member interaction. Often the conversation starts in a self-service channel. Using conversational AI, health insurers can increase self-service and automation rates and deflect transactional interactions from contact center agents — all while delivering an optimized member experience.
Reduce Friction in the Member Journey
Conversational AI optimizes every conversation by enabling agents to be more productive and empathetic while personalizing the experience for members. With a conversational AI and automation platform that can understand the customer’s real intent, emotions, and implied needs, contact centers can deliver a more conversational experience that eliminates friction in the member journey and
improves member satisfaction.
Member experience translates into billons of dollars for Medicare advantage plans
According to McKinsey, Medicare Advantage is the fastest-growing line of business for many health plans. Yet, those plans have been leaving an estimated $2.9 billion on the table in Stars-related payments by not optimizing the member experience2.
Stars is the Centers for Medicare & Medicaid Services (CMS) quality assessment program. Plans awarded 4 or more Stars earn a 5% bonus on CMS payment benchmarks, as well as higher rebates to use toward supplemental benefits for members. McKinsey estimates that Medicare Advantage plans in aggregate received approximately $12.2 billion in Stars-related payments in 2020.
However, there’s a change coming. A May 2020 rule from CMS indicates that customer experience metrics will begin to carry more weight in determining plans’ Star ratings. Instead of customer experience being around 32% of the total weight for 2020 ratings, the rule will see it increase to around 57% of the weight in 2023
Automate After-Call Work
What happens after the call ends can be just as important to your contact center’s business outcomes as what happens during the conversation. The time spent in after-call work (ACW) — including categorizing and summarizing the call, updating systems, and taking follow-up actions on promises made during the interaction — impacts average handle time, call waiting times, member satisfaction, costs, agent productivity, and agent satisfaction. Insurers can use conversational AI and automation to automatically handle ACW to achieve a remarkable return on investment.
Detect Overpayment Before It Happens
Beyond automating activities and tasks that humans routinely perform, conversational AI and automation can be deployed to perform tasks that humans cannot, such as analyzing millions of calls to detect patterns or analyzing every interaction to enable identification of potential overpayment before it happens.
Health insurer saves $6 million
A large health insurance company operates multiple contact centers with more than 1,000 agents that handle over one million calls annually. Call volumes were high because members were unable to find answers using self-service. After-call work was taking too much valuable agent time after the call and prevented the agent from participating fully in the conversation with the member.
After adopting Uniphore U-Self Serve and U-Assist for intelligent self-service and in-call agent assistance and automation of agent after-call work, the health insurer achieved:
reduction in average handle time
reduction in after-call work time
reduction in new hires due to automation
million in annual savings
If poor member and agent experiences, lengthy wait times, long average handle times, agent productivity, scalability, staffing, costs, and other member experience problems are the symptoms, then conversational AI and automation are the antidotes for what ails payer contact centers.
The advanced technologies described in the four use cases presented here are transforming the experience for members and agents. They’re enabling insurers to achieve measurable and sustainable business outcomes by delivering a positive,
frictionless experience for members and agents.
Take the next step and find out more about conversational AI and automation.
- “American Customer Satisfaction Index’s (ACSI) Finance, Insurance, and Health Care Report 2019-2020”
American Customer Satisfaction Index, November 2020
- “New Stars Ratings for Medicare Advantage Prioritize Customer Experiences”
McKinsey & Company, October 2020