| | AUGUST 201919CIOReviewConversation Platforms Significant advancements related to conversation platforms and related technologies have occurred over the last several years. New avenues have provided opportunities for businesses to serve customers more effectively and also reduce their operating costs. Conversational technology has seen increasing adoption across a wide range of industries including banking, telecommunications, healthcare, and finance. Healthcare Business LandscapeHealth plans sit in the center of a complex ecosystem, with various channels designed to communicate with each stakeholder group. Health plan customers (patients) often need to reach out to their health insurance company (payer) for information regarding their plans. This specific information can be associated with their individual benefits, such as coverage eligibility, finding doctors, and claim reimbursement. Doctors and nurses also interface with payers for touchpoints like confirming coverage and negotiating payment through pre-authorization. Payer investments catering to the needs of their constituent groups have yielded mixed results. Complex jargon/terminology and the maintenance of archaic technologies and solutions (e.g. mainframe databases) lend themselves to the difficulty in creating a comprehensive solution. As a result, customers often have a subpar consumer experience that would not be tolerated in other industries.The OpportunityConversational technologies coupled with AI/cognitive computing technologies such as natural language processing/understanding engines (NLP/NLU) and machine learning techniques offer an avenue to address this challenge. While they are not all new, these technologies provide innovative ways of navigating the complexities that have historically constrained traditional rules-based software systems. Using AI training models, these systems can be continuously trained to answer new requests (queries) from customers and evolve into a robust Q&A system that is able to address the most frequently asked queries. Likewise, the response to an inquiry can be customized to match the level of detail and jargon appropriate to the consumer. For example, a plain English language response can be presented to a customer, while a doctor or nurse can receive a response that includes significantly more technical healthcare detail. A typical customer query is, "what is the status of my claim?" Using NLP, a conversation platform can interpret SPEAKING THE LANGUAGE: CONVERSATIONAL PLATFORMS IN HEALTHCARE By Plamen Petrov, VP, Artificial Intelligence & Chief Data Officer & Reddi Gudla, Director-Technology, Digital Solutions & Experience, Anthem, Inc.Reddi Gudla
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