Elevance Health delivers exceptional experiences with AI & messaging

Elevance Health, formerly Anthem, Inc., has has been a disruptor in the healthcare industry - maniacally focused on elevating Whole Health and advancing beyond Healthcare. They are on an incredible journey evolving from a Health Benefits organization to a Lifetime, Trusted Health Partner. Their new brand Elevance Health, very aptly captures that transition.

It was an honor to host Geeta Wilson, Chief Technology Officer – Experience Platforms, Elevance Health at our IBM Think 2022 conference in Boston. Below is a replay from her session with Brian Loveys, Director, IBM - Data & AI. Official broadcast and other sessions are available at https://www.ibm.com/events/think/

Elevance Health has been on a mission to deliver exceptional digital-first AI-first experiences. Today, members of Elevance Health’s affiliated health plans can reach their health plan 24x7 via their award winning Sydney Health mobile app, Anthem.com website or switch to SMS from the IVR itself. Providers logged into Availity can seamlessly reach out to Elevance Health via chat, carrying the full context to expedite service.

Starting from 46M phone calls/year in early 2020, Elevance Health has had huge success moving 24% of those interactions to digital in under 2 years. It's been an honor for my team to partner with Elevance Health to co-create their digital and AI experiences. We committed to joint-outcomes, and have had a maniacal focus on improving customer CSAT and effectiveness of AI interactions.

Together, we combined the best-in-class capabilities from:

• Elevance Health's expertise in healthcare service experience, personalization, simplifying plan complexities, deep APIs, Natural Language search and app design

• IBM Consulting's expertise in Conversational AI, Large enterprise AI deployments on hybrid clouds, Experience design, Healthcare specific AI Development toolkit, advanced orchestration and Conversational Insights

• IBM Watson Assistant for Conversational AI

• LivePerson conversational cloud for async messaging

Today, Sydney Health confidently answers complex healthcare questions like: How much of my claim payment is remaining? How do I pay my claim? What is my benefit coverage? What’s covered in-network? What is my co-pay? Etc. We define Conversational AI Maturity in three levels:

• Level 1 'where' - foundational questions like 'where do I find my pending claim details?', 'where do I look for maternity coverage?' etc. These are simple queries, where AI needs to accurately understand the intent and navigate the user to the appropriate self-help.

• Level 2 'what' - personalized responses to questions like 'what’s my HSA balance?'. 'what's the status of my claim?', 'ID card', 'auth status' etc. These require an understanding of the intent, and orchestrating APIs at the back end to provide quick responses. Very deterministic quick conversations.

• Level 3 'why' - these were traditionally reserved for human SMEs and CSRs answering complex questions like 'why was I billed $300?', 'why was the x-ray not covered?', 'NIPT coverage' etc. These require AI to emulate a subject matter expert and leverage Content Intelligence to read unstructured documents, maybe trigger automation scripts, dynamically change the dialog based on a care gap alert from an Enterprise AI model etc. Moving to Level 3 conversations has helped Elevance Health automate complex conversations like cost share, benefit explanation etc., delivering high AI effectiveness with higher CSAT. Elevance Health continues to be an industry leader in member experiences by continuously maturing conversations to Level 3.

"IBM Consulting and Elevance Health have a very authentic partnership. We co-create and have joint outcomes. IBM is vested as much as we are vested.. always rolling up their sleeves, wearing the problem solving hat" - Geeta Wilson, Elevance Health CTO – Experience Platforms

It was a blast hosting Geeta at THINK, and interacting in person with our incredible clients. She also joined a cross-industry panel with Keith Pate, VP Planning & Strategy @ Lumen, Evan Hovorka, Head of Retail Media Products @ Albertsons and Jennifer Quinlan, Managing Partner, iX & Customer Transformation, IBM. It was great to see the contrast of how various brands across industries serve the same end customer and how they are leveraging AI and digital to delight us. There was unstoppable energy at Think, with AI infused across every discussion from customer transformation, robotics, talent, supply chain, to hybrid clouds.

Big shout out to Anil Bhatt, Geeta Wilson, Kumar Gudavalli, Ajoy Ranga, Kim Rival, Sangeeta Dutta, Jeff Van Ornum, Terrance Holbrook, Sean Long, Shon Das, Dileep Das and the entire Elevance Health family. Cheers to the IBM AI Avengers Glenn Finch, John Tarcson, Vineet Kaushik, Ambhi Ganesan, Michael Choie, Suchetan Bhattacharya, Vinod Munagala, Arun Chandran and the entire IBM family.