How AI and automation will simplify the benefits landscape
A transformative shift is underway, and it’s much bigger than simply adopting cutting-edge technology.
Survey says…
Recently, the Kaiser Family Foundation (KFF) published the findings of its KFF Survey of Consumer Experiences with Health Insurance, shedding light on the pervasive difficulties Americans face in dealing with health insurance. Respondents cited authorization denial, higher bills and trouble finding in-network doctors as notable hurdles, underscoring the complexities of accessing essential health care services. Perhaps unsurprisingly, affordability was a dominant theme, with 40% of respondents having delayed or foregone necessary care due to financial constraints.
Remarkably, over a quarter (28%) of those facing insurance issues reported having to pay more for their care on account of these problems, highlighting that uncertainties in insurance coverage can translate into unexpected financial burdens for those seeking medical treatment. Looking deeper, the KFF survey also found that almost one-third (30%) of respondents struggled to interpret the specifics of their coverage, adding yet another layer of confusion to the complex landscape.
Simplifying the benefits landscape
A policy brief entitled “Health Insurance Complexity Leads to Consumer Wasteful Spending” from the University of Connecticut’s (UConn) Health Disparities Institute hammers home how the complex nature of insurance contributes to inefficient expenditures, emphasizing the need for transformative solutions. AI and automation stand out as a pair of technologies more than capable of simplifying the way people understand the intricacies of their health insurance.
Strategic implementation
To demonstrate how AI and automation can revolutionize the way people understand their benefits, let’s examine a compelling use case. A prominent fintech company in the health care space strategically employed an innovative AI-driven customer experience (CX) solution, enabling users to gain profound insights into various facets of their coverage and addressing critical pain points outlined in the KFF survey. The wide-ranging benefits comprehension solution aimed to empower users in the following areas:
Understanding benefit usage: The AI-driven solution provided users with clarity on how to effectively utilize their health benefits, overcoming challenges individuals face in grasping the nuances of coverage.
Identifying authorized products: Users could effortlessly identify products authorized for purchase with their member benefits or credits. This modernized approach assists individuals in making informed decisions about their health care purchases.
Checking remaining amounts: The solution enabled users to view the remaining amount on their benefits plan easily. Such transparency is pivotal in preventing unexpected costs and helping plan healthcare expenditures.
Automation in contact centers
Another part of the fintech company’s strategic initiative was the implementation of automation in its contact centers, which resulted in a wide array of advantages. By automating such routine tasks as card activation, agents were freed up to focus on providing high-value insights to customers. The tactical deployment of automation empowered users to better understand and utilize their benefits without the need for human interaction, fostering a more efficient and user-friendly overall experience.
In 2022 alone, over 40 million calls were successfully automated, reflecting the scalability and effectiveness of the AI solution. The automation rollout takeaways could potentially include:
Self-service rate of 60%: A remarkable self-service rate of 60% suggests that users can embrace and effectively pilot the automated features to gain an understanding into their benefits.
Call containment rate exceeding 75%: Additional automation integration provides a path to exceed 75% call containment rent, accentuating the efficiency of the automated platform in resolving queries as concerns within the automated system itself.
These outcomes are indicative of the practical impact of AI and automation on consumer interactions, transforming the way people engage with and understand their health benefits.
Shaping the future of benefits understanding
As the benefits landscape continues to evolve, the success of this use case serves as a testament to the industry-changing potential of AI and automation. By reshaping how benefits are understood and accessed, these technologies lead the way toward a future in which individuals can more confidently and capably make sense of the many intricacies associated with health benefits. This case study is but one example of strategic AI deployment successfully nurturing a user-centric and transparent approach to understanding health benefits.
Empowering employees in the AI era
As the marriage of AI and automation completes its overhaul of how people understand their health insurance benefits, a unified approach is key to navigating this brave new world. Insurance brokers, advisors and benefits professionals must collaborate to ensure a seamless consumer experience. Equipped with a nuanced understanding of the technologies at hand, these parties appear as integral facilitators in empowering consumers to make informed decisions. The journey to a future where benefits understanding is fair and accessible for all requires a collaborative effort, with benefits professionals playing a primary role in guiding clients through the minutiae of all the AI revolution has to offer.
Matt Edic is the Chief eXperience Officer at IntelePeer.