It’s no secret that health plans tend to be complicated systems, and those who don’t need help navigating them to understand their benefits are few and far between.
To that end, IBM’s Watson Health recently announced a collaboration with Humana Employer Group that will tap IBM’s conversational AI solution to Humana members, agents and employer-customers better understand their healthcare benefits and costs.
In a statement, the two organizations pointed to research that makes clear that consumers who don't understand how their health plan works, or how to estimate out-of-pocket costs, are more likely to delay or avoid essential care.
To help rectify that problem for Humana stakeholders, Humana will deploy IBM Watson Assistant for Health Benefits, an AI-enabled virtual assistant built in the IBM Watson Health cloud. The IBM Watson solution is designed to understand the logic of health plan eligibility and incorporate it into the member conversation, enabling improved interaction with each member, and personalizing each answer to the Humana member based on his or her active or future health plan
“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.”
Watson Assistant for Health Benefits utilizes a conversational virtual assistant with member benefits, coverage, claims, referrals and healthcare costs for Humana Employer Group members, agents and employer-customers, and the service will be available to all of Humana’s 1.3 million Employer Group medical members, and 1.8 million of Humana’s Employer Group dental members.
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,” said Paul Roma, General Manager, IBM Watson Health. “We are proud to support Humana in leading the effort to deploy conversational AI to help enhance and improve the consumer experience.”
According to the two companies one of the key benefits of the Watson assistant is addressing questions directly from members with speed, accuracy and personalized answers.
It can also help Humana employees and call center personnel answer questions quickly and accurately, helping to free up more time for customer care representatives to provide concierge-level customer service. It uses historical claims and provider data to calculate personalized cost estimates for medical services with the goal of helping Humana members better manage their healthcare spending.