Healthcare Compliance & CX with AI Analytics | Uniphore

Healthcare Compliance & CX with AI Analytics | Uniphore

Few industries are as closely regulated as healthcare. Service providers must comply with a constantly evolving list of privacy, financial and medical disclosure guidelines. Failure to comply, even in part, can result in serious monetary consequences. According to the National Center for Biotechnology Information (NCBI), between $100 and $300 billion of avoidable health care costs have been attributed to nonadherence in the U.S. annually, representing 3 to 10 percent of total U.S. healthcare costs. It comes as no surprise then that compliance-related tools and programs are among the industry’s leading business investments.

However, compliance isn’t the only factor driving healthcare business decisions today. In the wake of the global pandemic, customer experience (CX) has risen to new prominence as more patients and members are interacting with healthcare service providers remotely. What digital customers are seeing often isn’t pretty: complex processes, redundant steps and time-consuming resolution journeys. Healthcare CX, it seems, is as complicated and convoluted as healthcare compliance. But does it have to be?

Advanced technology is making change possible.

Healthcare compliance and customer service have traditionally been human-led enterprises, staffed by subject experts with access to a vast wealth of manual tools and data. While amply equipped, compliance and CX departments nevertheless struggled with efficiency. Humans are, after all, human; manually searching through volumes of protocols and procedures takes time and isn’t always accurate. For patients and members with CX requests, this often translates into long hold times and sometimes incomplete resolutions. For those tasked with enforcing compliance, overlooked details or manual errors can result in serious losses.

Artificial intelligence, unlike the human brain, is immune to fatigue, boredom and distraction. AI can perform complex tasks quickly, repetitively and—most importantly—accurately. In the healthcare environment, AI can analyze millions of interactions for compliance issues and alert compliance staff to discrepancies, omissions or incomplete disclosures. As a result, compliance departments can save significant time and money while greatly improving process accuracy.

On the CX side, the technology has reached a level of maturity that allows for real-time interaction with actionable feedback based on patient and member emotion, sentiment and intent. Armed with next-generation AI, healthcare service providers can deliver a seamless end-to-end consumer journey—from faster self-service with fewer steps and redundancies to more efficient live interactions with higher customer satisfaction (CSAT) and first contact resolution (FCR) rates.

AI-powered analytics optimize patient and member services.

Consumer expectations today are higher than ever. Shaped by pandemic-accelerated digital proficiency, consumers have been conditioned to expect prompt, user-friendly service from all their product and service providers. Healthcare is no exception. In an article on the Top 10 Emerging Trends in Health Care for 2021, the American Hospital Association (AHA) made the following observation:

Today we can receive goods the same day we order them and track them minute by minute from order placement to delivery. It’s not surprising that patients expect the same high level of efficiency and transparency from their health care providers. Instead, some patients may have to wait weeks or months for an appointment and have only a vague idea of when exam results will be available. Organizations need to assess their current barriers to consumer satisfaction and deploy analytics and patient-centric technologies to improve the convenience, speed and transparency of care.

AI-powered analytics optimize the patient or member journey, collecting relevant data that can simplify on-call processes and streamline post-call actions. For example, AI can “read” real-time interactions, recording where promises are made and automating follow-up communications like appointment confirmations and claim status updates. This adds greater confidence and continuity in the healthcare consumer experience.

Artificial intelligence humanizes and personalizes healthcare CX.

Artificial intelligence can do more than just transcribe and analyze factual data. Advances in interaction analytics now make it possible to better understand a patient’s or member’s emotional state, sentiment and intent. This data allows healthcare service providers to create positive, highly personalized experiences that build consumer trust and improve provider reputation. By analyzing user responses for context, AI can tailor the consumer journey accordingly and even inject empathy where needed. In this way, technology can actually help “humanize” an often-impersonal dialogue.

And studies show that empathy matters. In a recent Deloitte survey, consumers ranked empathy and reliability as the top two factors when seeking out a healthcare experience. Based on its findings, Deloitte drew the following conclusion:

To maintain or even re-earn the trust of consumers, healthcare organizations should demonstrate reliability, transparency, and, most importantly, a sense of empathy in how they conduct operations moving forward. As consumers consider their options for where they’ll get their care, healthcare leaders could inspire in them a sense of control that helps reduce uncertainty and enable the right connections to help consumers get the resources they need.

In other words, empathy nurtures consumer agency and creates a stronger sense of provider advocacy. This not only adds confidence that healthcare organizations have their patient’s or member’s best interests at heart, but also implies that providers are working progressively toward resolutions that benefit their members. Without AI-powered analytics, delivering this level of personalized, positive attention to each member would be challenging for even the best-trained staff—and nearly impossible for self-service platforms.


Meeting today’s strict compliance requirements and consumer expectations is no easy task. Even the best training and the largest resource libraries cannot fully inoculate organizations from human errors and process inefficiencies. To emerge competitive—and possibly even viable—in today’s increasingly digital landscape, healthcare service providers would be wise to take a page from CX leaders in other industries. By augmenting staff capabilities with artificial intelligence and automation, providers can strike the perfect balance between human attention and machine efficiency, while creating a more personalized, satisfying and confidence-inspiring experience for patients and members overall.

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