How Artificial Intelligence is Helping the Member Experience

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When Reymond Acosta answers the phone in a UnitedHealthcare call center, he’s ready to be a supportive resource. As an Advocate4Me representative, he works to answer members' questions and clear up any confusion related to their health care.  

In order to do this, advocates must gather and research personal information to verify the caller. This important step can add time to the call, which can delay how quickly advocates are able to answer questions for the member. But a new capability using artificial intelligence (AI) is working to streamline this process — for both the advocate and the member. 

UnitedHealthcare is scaling Agent Virtual Assistant, also known as AVA, starting in San Antonio, TX with the experience and implementation team. The capability is a chatbot that uses AI to communicate with health advocates and will be scaled to additional E&I locations this year.

“Behind the scenes, AVA is pulling data in for each specific member that calls in,” said Stephen Packen, senior product analyst for digital marketing capability at UnitedHealthcare. “What’s excellent is that the agent is not having to navigate through multiple systems to pull the data, AVA is doing that for them.”

AVA supplies the advocates with answers to basic questions through a chat interface, which gives them what they need in seconds. The ease of finding information has allowed advocates to focus more on the member and less on digging through information – making the experience more conversational rather than transactional. 

“A lot of the times people are already a little frustrated when they're calling in,” Reymond said. “[AVA] really streamlines their call and answers the question a lot quicker. They don't have to be frustrated on top of the situation by spending the time on the phone.”

The transparent nature of software allows agents to go one step further, offering clear data that helps guide consumers to the care that’s right for them. If a member called to ask about where to go for care, AVA would bring up the different member specific benefits for that provider or site of service. In the future AVA will even make suggestions based on what we know about that member.  The ease of finding this information gives Rey the time to ask additional questions, so he can help that member choose the best place for care, which may lead to cost savings. 

“After reviewing a claim or even better, when they're preparing for a service, it's great for us to throw in those opportunities like saying your doctor is sending you to the hospital to do this x-ray. You might save some money if you go to an independent facility,” Rey said. “No matter what the attitude of the person at the beginning of the call, knowing that I was able to assist them in a timely fashion that puts respect for their time, it really is something that makes me feel great.” 

While still in the early stages of roll out, the capability is constantly being analyzed to improve efficiency. That data will be used as the foundation for what may eventually become a member-facing virtual assistant. 

“We want to help reach that member at significant points in their journey to make an impact both on the cost and the outcome of their healthcare.” said David Wietecki, director of digital capability at UnitedHealthcare. “In order to do so, we need the proper foundation innovation pieces in place to make that contact possible.”

AVA is just one of the innovations across the organization that are working to improve the member experience. As UnitedHealthcare continues to investment in these types of capabilities, they are working to lace them all together into a cohesive picture. 

“Individually they’re good. When we put them together and have those capabilities interact, they become great,” David said.