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Humana, one of the largest health insurance providers in the U.S., has successfully partnered with IBM to harness the power of AI to improve its provider experience. This collaboration is revolutionizing how Humana meets the increasing demand for faster and more efficient customer service in the healthcare and insurance industries.
Humana faced significant obstacles in meeting its customer service needs, including:
High call volume and high expense: The company received over one million calls per month from providers, mostly routine inquiries that could have been resolved through Interactive voice response (IVR) without human intervention.
Inefficient legacy solutions: The existing IVR system was ineffective, leading to high operational costs and customer dissatisfaction.
Rising customer expectations: Customers increasingly demanded quick, accurate responses, prompting Humana to seek an efficient, scalable solution to enhance its customer services.
To overcome its customer service challenges, Humana partnered with IBM to leverage the power of IBM Watson conversational AI. This collaborative effort resulted in the development of the Provider Services Conversational Voice Agent, a solution that underwent extensive proof-of-concept development and iterative refinement over several years.
1. Collaboration and Partnership: Humana and IBM Watson teams worked closely together to design and deploy the AI-based solution on IBM Cloud and Humana locations.
2. Watson Assistant Development: The solution enabled healthcare providers to access medical eligibility, benefits, and referral information through self-service, reducing the need for live agents.
3. AI-Driven Personalization: Watson AI was trained to understand healthcare terminology, handling specific sub-intents like claims and authorization with over 90% accuracy, thanks to speech customization.
Humana partnered with IBM Watson® and IBM® Data and AI Expert Labs & Learning (DAELL) to develop the Provider Services Conversational Voice Agent. After a successful three-month proof of concept, they implemented a solution that integrated multiple Watson applications into a single conversational assistant, hosted on IBM Cloud® and utilizing Watsonx™ Assistant for Voice on-site at Humana.
This voice agent, powered by AI, efficiently and consistently provided eligibility, verification, and authentication information for administrative staff at healthcare providers, eliminating the need for live agents. The solution included customized speech features, incorporating seven language models and two acoustic models.
Humana has experienced various improvements after joining hands with IBM Watson, including:
1. Cost Effectiveness: The Watson-based system handles calls at approximately one-third the cost of the previous system, leading to significant savings on operational expenses.
2. Efficiency: The Voice Agent responds to queries at one-third the cost of the old system while providing overall faster responses and improved accuracy.
3. Accuracy: With speech customization, the system has achieved a sentence error rate of only 5% to 10% when addressing complex health-related queries.
4. Enhanced Customer Satisfaction: The new solution offers straightforward and relevant responses, including details about the types of benefits offered, which streamlines procedural requirements.
5. Scalability: The system is capable of managing over 7,000 voice calls from 120 providers each day, creating large-scale opportunities for customer service operations.
Founded in 1961, Humana is a prominent health insurance company in the United States, serving over 13 million customers. Its comprehensive portfolio includes Medicare, pharmacy benefits, and various other options to cover medical expenses.
As a global leader in AI, cloud computing, and business solutions, IBM empowers businesses to transform their operations with cutting-edge technologies like Watson. IBM Consulting specializes in delivering AI-powered solutions that drive innovation and process optimization for forward-thinking companies.
Humana's partnership with IBM Watson has revolutionized the company's approach to customer service. This collaboration has reduced operational costs while improving response times, resulting in a better experience for healthcare providers. The case study clearly illustrates the advantages a healthcare insurance company can gain by implementing artificial intelligence in its customer service, allowing it not only to meet the expectations of modern customers but also to exceed them.
