How healthcare payers can win in the world of the cognitive enterprise

By and Carrie Worley | 5 minute read | January 14, 2020

A new era of business reinvention is dawning that will accelerate disruption and reshape health insurance. With increasing pressure to improve customer experience, manage the explosion of data, and harness the potential of artificial intelligence (AI) and smart technologies to differentiate and drive growth, payer organizations must evolve to the next generation model for digital transformation — what we call the “Cognitive Enterprise.”

Shifting to a cognitive enterprise involves more than integrating cutting-edge technology. It requires a complete rethink of organizational culture, structures, and processes, powered by optimized use of data. Only then can a business move faster and smarter, enabling intelligent operations and continuous insights-led, customer-focused innovation.

The path to a cognitive enterprise is a transformation journey, but there are several elements for a winning strategy and concrete actions that can help you succeed.

So, what is the cognitive enterprise?

Digitally connected, cognitive organizations better understand customers and quickly pivot from insight to action. Championing change, they anticipate disruption, exploiting data and technologies to push into new directions, while enabling an agile workforce and improved market responsiveness.

Most organizations are just beginning to prepare for the monumental changes that will characterize the coming decade, fueled by unprecedented technology convergence. Cognitive enterprises are investing now to continue their journeys to the cloud and AI, experiment with new technologies, shift applications and infrastructures from legacy to new, and advance digital capabilities.

They’re also adapting organizational models and mind sets to optimize ways of working, enable new skills, and empower employees to innovate ideas and approaches that better meet customer needs.

Improving member experience

Cognitive technologies, such as AI and machine learning, enable healthcare payers to make sense of the massive amounts of data they collect and uncover meaningful insights at unprecedented speed. Designed to comprehend, reason and learn, AI automates real-time insights, revealing deep connections for a more nuanced understanding of individual customers and their health journeys.

Armed with this knowledge, payers can dissect how customers research, obtain and use health insurance, and they can tailor support to help consumers navigate decisions, meet wellness goals and effectively manage medical events, conditions and life stages.

Multidimensional intelligence also allows payers to personalize member experiences and drive proactive engagement, anticipating needs, shaping new products/services and solving issues or communication gaps, while predicting what customers are likely to want or need next. Creating a fuller picture of the customer experience, payers can improve trust, as well as satisfaction.

Empowering employees

Cognitive enterprises are embracing smart tools to drive new capabilities and streamline processes, to change how work is done. Combining technologies such as AI, multicloud, Internet of Things (IoT) and blockchain, organizations are building intelligent workflows that improve decision-making, as well as administration and delivery of care.

But digital transformation isn’t just about technology; it’s also about people. Cognitive organizations recognize they must build the workforce and culture needed to enable agile innovation and customer-centricity. They empower employees with more trust and autonomy, forming dynamic, collaborative teams that continually look for new ideas and approaches to better serve customers, enhance skills and improve work processes.

Optimizing interactions between smart machines and even smarter humans, cognitive organizations let employees move quickly from insights, to smart experimentation and consequent action, to rapidly respond to opportunities and market changes.

Advancing digital platforms

Design thinking, co-creation and agile approaches allow cognitive organizations to design integrated business platforms that deliver the perfect fusion of technology, powered by data to create more agile, intelligent services.

Developing a customer-centric, platform ecosystem that brings together cutting-edge technologies, underpinned by data, organizations can deliver successful customer, employee and partner experiences. The strategy for this modern platform architecture should:

  • Redesign company workflows around AI: Designing business platforms that leverage the full power of data and AI to create smarter workflows, automate and digitize operations, and enable new capabilities, while ensuring deeper interoperability and connectivity with the ecosystems and networks that support customers.
  • Support agile delivery: Optimizing AI-driven data, marketing, customer and CRM platforms, and linking these with other operational systems, can automate real-time data analysis, speed knowledge sharing and eliminate functional silos. This fuels agile collaboration and responsiveness, meeting customer needs in the moment.
  • Connect customer touchpoints: Consumers expect companies to know them and provide individualized, on-demand, responsive services. AI-powered platforms enable organizations to connect in relevant ways, engaging members with personalized, timely interactions and delivering integrated experiences across touchpoints.
  • Deliver trust and security: Trust in data is at the heart of cognitive workflows and decision-making, requiring organizations to ensure both the human and machine elements of key workflows and data sources are secure.

Transforming customer support

Imagine a cognitive assistant that can engage customers in real conversations, understanding what people say, as well as what they mean, and even detect sentiment and context to respond in meaningful ways. Sophisticated AI-driven speech recognition systems are using real-time data to enable conversational assistants to deliver on-target customer support, 24-7.

Offering consumers instantaneous answers, these cognitive assistants can help people connect to the right information, navigate choices and even complete health-related tasks. By removing the complexity of touchscreens and keyboards, they simplify interactions, expand self-service opportunities and can also entertain and educate members.

Because they offload routine inquiries, cognitive assistants also free up live agents to focus on more complex problem resolution. These tools can deliver convenient, personalized support, helping to strengthen brand connections and member satisfaction.

Building for the future

To make the shift to a cognitive enterprise, organizations will need to keep the human factors front and center, while considering how smart technologies can advance digital transformation to enhance both customer and employee experiences.

The winning formula will enable customer centricity, agile operations and smart workflows. It will also position the organization to differentiate their brands, better serve members and unlock growth. Now is the time to define the roadmap to deliver value in both the short and long term, capitalizing on the continual disruption that comes from being a cognitive enterprise driven to build the future of healthcare.

Learn how IBM can help you create intelligent workflows to reimagine your business processes.

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