The Future of Customer Service for Health Plans

Blog /The Future of Customer Service for Health Plans
NTT DATA Blog 14

Imagine your members having a conversation with their health coach on a laptop, tablet, or smart phone. Now imagine that this is a virtual coach rather than a real person. The virtual coach would be able to discuss ongoing management of a chronic disease, or follow up on the member’s recent hospital discharge. Imagine that same coach answering questions, sending medication and appointment reminders, monitoring vital stats and helping coordinate your member’s entire care team, all while gathering and reporting data to continually improve care. Would that by useful to your health plan?

Imagine if you had a virtual agent in the customer contact system that could recognize your members by their biometric voiceprints, access their data and respond to open-ended questions, even anticipating the next question. Imagine “the voice” on the other end of the phone “understanding” your members’ queries the first time they ask, and being able to access multiple knowledge bases at the speed of thought to always deliver the correct and consistent responses. Imagine a virtual agent so adept that your members would forget, at least for a moment, they aren’t talking to a live person, but a machine.

Imagine how it would improve service if your health plan members could enroll via an intelligent virtual assistant — a bot — certified by the Center for Medicare & Medicaid Services as a licensed agent. Imagine that being a simple and stress-free experience where members are provided a transcript of their responses within minutes. Would that reduce the number of calls to your live agents, leaving them free to handle more complex customer calls?

The good news is that you don’t have to imagine. After 30 years of cognitive research and significant advances in artificial intelligence and machine learning, today’s natural language understanding engines are capable of all that. Incorporated into an “active learning” platform, they provide speed, accuracy, and high levels of customer satisfaction.

Intelligent virtual assistants, combined with backend analytics, flow optimization, error checking, and integrations to APIs, can provide a true omni-channel customer experience, scalable to demand, at a fraction of the cost of human customer service agents.

Fear not, humans. Artificially intelligent virtual assistants are not meant to replace human support in healthcare customer service, but elevate and enable it. The most difficult calls will still go to live customer service agents. The deflection of routine calls to automated channels will free up the top tier of customer service (live agents) to focus on the difficult calls, with less concerns over answer speed and handle times. It’s a win for both the health plan and its members and providers.

The technology is already out there. The next time you open a chat window to discuss an issue with your wireless service provider, or call Apple about your iPhone, ask yourself: Am I talking to a human operator or a bot? 

I explore this topic more in-depth in a recent white paper you’ll want to read.

Post Date: 9/14/2017

Martin Klein Martin S. Klein, D.P.M.

About the author

With a background in clinical medicine, technology and research, Dr. Klein has been delivering strategic business solutions to healthcare and other sectors for more than 25 years. At Cigna Healthcare, he was the architect of a contact center outsourcing strategy that helped increase operational effectiveness and efficiency in service operations. In addition, he helped drive the strategic and tactical BPO of Cigna clinical member and provider services.

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