The following remarks from EXL have been lightly edited for clarity and length.
1. Healthcare leaders are stepping up their investments in AI
Faced with rising healthcare costs, shrinking budgets, demands for transparency and rising member expectations, many healthcare executives are looking to gain an advantage. Payers are turning to 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 EXLa leading data analytics, operations and digital solutions company, more than three-quarters of respondents said implementing generative AI technology was a high or top priority this year. Nearly 67% said they would increase their investments in generative AI capabilities over the next two years, and 11% say they plan to increase their spending by 50% or more.
As generative AI capabilities continue to be proven in practical use cases, their implementation will need to evolve rapidly. Payers will need to partner with companies that have expertise in healthcare, not only in technology, but also in data management, analytics, architecture, governance, privacy and security. security.
2. Better Member Understanding Improves Member Experience
The Forrester study also looked at payers’ top business goals and found that the top answer, 42 percent, was to improve the member experience. However, only 19% of respondents said they want to further develop their ability to generate insights from member data.
While all of these goals are laudable, the ability to generate insights from member data could have the most meaningful and impactful outcome, because ultimately, it is this data that powers AI capabilities . If an organization’s primary business goal is to improve its member experience, generative AI technology can quickly find detailed information about what members want and expect.
In turn, organizations can use this information to develop personalized communications, creating a strong feedback loop for continuous improvement. Every healthcare member’s digital journey must be built on a solid foundation of trusted customer insights using generative AI technology to personalize each member’s preferences.
3. Generative AI Improves Employee Experience, Leading to Happier Members
Healthcare leaders are turning to generative AI technology in hopes of addressing industry challenges more effectively. Today, according to the Forrester study, organizations are using generative AI capabilities for outward-facing applications. The most common use cases are member-provider communications (43%) and member-payer interactions (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 respondents reported using generative AI technology for knowledge access, management and retention. As organizations today focus much more on outward-facing applications, innovative and forward-thinking healthcare leaders will also use generative AI to improve their employee experiences.
By making it easier for employees to find the right information at the right time (and offloading mundane, AI-heavy tasks like data entry), payer organizations can retain talent and provide a more enjoyable employee experience. employees and members.
4. Contact centers are transforming into personalized, user-friendly experiences
Today, contact centers at payer organizations still focus on humans answering incoming phone calls, with Forrester research revealing that 70% of an agent’s time is spent initiating a conversation, searching for information and to document the call. Generative AI technology could change every aspect of this job and dramatically improve employee retention and member satisfaction.
Payers must look beyond traditional approaches to modernize their contact centers to create a seamless, personalized experience for patients, members and providers. Using AI technology, data collected in the call center can be analyzed to better understand patient segments and interactions. Using this data, payer organizations can identify friction points within their delivery system, develop personas to reinvent experiences, and continually optimize and rebalance resources to meet demand.
Once a baseline has been established and opportunities for improvement have been identified and prioritized, EXL advises organizations to integrate three key AI technologies into contact center digital transformation: digital agents conversational AI, a generative AI co-pilot, and digital AI audits.
5. Data management is now the best place to start
As payers move toward AI, generative AI, and successful digital transformation, they will need to ask the critical question of where to start. What are the most important steps an organization should take to prepare to implement these capabilities?
The Forrester study asked this very question. The lesson learned is that 81% of respondents said their organization was not ready to leverage their data for AI, meaning payers underestimated the importance of data and overestimated their readiness.
At EXL, we fully agree with this strategy for payers: strong data management is the prerequisite for generative AI success. Combined with deep healthcare expertise, 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.