The following remarks from EXL have been lightly edited for clarity and length.
1. Healthcare Leaders Are Ramping Up AI Investments
Facing rising healthcare costs, shrinking budgets, transparency demands and increasing member expectations, many healthcare leaders are seeking an edge. Payer organizations are looking at generative AI technology to help them address these multiple pressures. In doing so, these companies are making a significant financial investment in generative AI capabilities.
According to a recent study conducted by Forrester on behalf of EXL, a leading data analytics, digital operations and solutions company, more than three-quarters of respondents said that implementing generative AI technology is a high or top priority this year. Nearly 67% indicated they will increase investment in generative AI capabilities over the next two years, with 11% saying they plan to increase spending by 50% or more.
As generative AI capabilities continue to show success in practical use cases, implementation will need to scale quickly. Payer organizations will need to partner with companies that have healthcare domain expertise not only in technology, but also in data management, analytics, architecture, governance, privacy and security capabilities.
2. Deeper Member Understanding Is Improving The Member Experience
The Forrester Research also looked at the key business goals of payer organizations and found the leading response, by 42%, was to improve member experience. However, only 19% of respondents said that they wanted to further develop their ability to generate insights from member data.
While all of these are worthwhile goals, the ability to generate insights from member data could have the most significant and impactful outcome, because ultimately this data is what fuels AI capabilities. If an organization’s leading business goal is to improve the member experience, generative AI technology can quickly find detailed insights into what members want and expect.
In turn, organizations can use these insights to develop customized communications, creating a strong feedback loop for continual improvement. Every healthcare member’s digital journey should be built on a solid foundation of reliable customer insights by utilizing generative AI technology to personalize each member’s preferences.
3. Generative AI Is Enhancing The Employee Experience, Leading To Happier Members
Healthcare leaders are turning to generative AI technology with the hope of addressing industry challenges more effectively. Today, according to Forrester’s study, organizations are using generative AI capabilities for outward-facing applications. The most common use cases are member-provider communications at 43%, and member-payer interactions at 41%, including claims, prior authorization, care recommendations and cost management.
Currently, healthcare leaders are less likely to use generative AI capabilities for internal use cases. Only 31% of survey respondents said they were using generative AI technology for knowledge access, management and retention. While organizations today are much more focused on outward facing applications, innovative and forward-looking healthcare leaders will also use generative AI to enhance their employee experiences.
By making it easier for employees to find the right information at the right time—and offload mundane tasks that are strongly suited for AI such as data entry—payer organizations can retain talent and provide a more enjoyable experience for both employees and members.
4. Contact Centers Are Turning Into Consumer-Friendly, Personalized Experiences
Today, contact centers at payer organizations are still focused on humans answering incoming telephone calls, with the Forrester study finding 70% of an agent’s time is spent engaging in conversation, finding information and documenting the call. Generative AI technology could change every part of this work and dramatically improve employee retention and member satisfaction.
Payer organizations need to look beyond traditional approaches to modernize their contact centers to create a seamless, customized experience for patients, members and providers. Utilizing AI technology, data collected in the call center can be analyzed to better understand patient segments and interactions. With this data, payer organizations can identify friction points across their delivery system, develop personas to reimagine experiences and continuously optimize and rebalance resources to meet demand.
Once a baseline has been established and improvement opportunities have been identified and prioritized, EXL advises organizations to incorporate three key AI technologies into the call center digital transformation: conversational AI digital agents, a generative AI copilot and AI digital audits.
5. Data Management Is Now The Best Place To Start
As payer organizations move to embrace AI, generative AI and digital transformation success, they will need to ask the critical question of where to start. What are the most important steps an organization should take to prepare for implementing these capabilities?
The Forrester study asked this very question. The lesson learned was that 81% said their organization wasn’t prepared to harness their data for AI, meaning payers underestimated the importance of data and overestimated data readiness.
At EXL, we are in full agreement with this strategy for payer organizations: strong data management is the prerequisite for generative AI success. Combined with deep domain expertise in healthcare, EXL helps clients organize, integrate and secure healthcare data to unlock their greatest potential with generative AI technology, digitally transform their organizations and improve the health of their members.