Humana and IBM Watson Health to simplify member experience for Humana Employer Group customers

Watson Assistant for Health Benefits can help enable greater access to accurate information about healthcare costs and more for Humana Employer Group customers.

By | 1 minute read | February 11, 2021

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The shift to a more consumer-driven healthcare system has accelerated the need for cost-effective solutions that help health plans transform the member experience.

Humana and IBM Watson Health are collaborating to leverage IBM’s conversational artificial intelligence (AI) solution – to help provide a better member experience while providing greater clarity and transparency on benefits and other related matters for Humana Employer Group members.

Research indicates that consumers who do not understand how their health plan works or how to estimate out-of-pocket costs are more likely to delay or avoid essential care. Watson Assistant for Health Benefits aims to help address this issue by leveraging conversational AI—enabled by natural language processing—to streamline the engagements between agents, employers, and Humana Employer Group members with clear and accurate information on benefits, healthcare costs and providers.

As part of the agreement, Humana will deploy Watson Assistant for Health Benefits, an AI-enabled virtual assistant built in the IBM Watson Health cloud. Initially, the service will be available to all of Humana’s 1.3 million Employer Group medical members, and 1.8 million of Humana’s Employer Group dental members. Watson Assistant for Health Benefits provides rapid, accurate and helpful information utilizing a conversational virtual assistant with member benefits, coverage, claims, referrals and healthcare costs for Humana Employer Group members, agents and employer-customers. The objective is the creation of a cloud native AI platform powered by IBM Watson with the conversational AI chat solution.

Humana and IBM plan to deploy Watson Assistant for Health Benefits to help many aspects of the Humana Employer Group member benefits experience, including:

  • Addressing questions directly from members with speed, accuracy and personalized answers
  • Assisting Humana employees and call center personnel to accurately answer questions quickly – helping to free up more time for customer care representatives to provide concierge-level customer service
  • Using historical claims and provider data to calculate personalized cost estimates for medical services that can help Humana members better manage their healthcare spending

The Watson Assistant for Health Benefits solution is designed to understand the logic of health plan eligibility and incorporate it into the member conversation, enabling improved interaction with each member, and personalizing each answer to the Humana member based on his or her active or future health plan.