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| March 2, 2021

Humana Partners With IBM to Provide AI Health Benefits Assistant to Employer Members

Anca Spanu

Anca's career in journalism spans over 2 decades. She has served as staff writer, editor and deputy chief editor at... Anca's career in journalism spans over 2 decades. She has served as staff writer, editor and deputy chief editor at various media outlets all over the world. At Healthcare Weekly, Anca writes about current events, innovations in the healthcare space and events/ conferences with a focus on investing & startups.

Watson Health announced on February 11th a collaboration leveraging 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.

AI in healthcare, a way for more people to access information and the needed care

The role of artificial intelligence in healthcare has been a huge talking point in recent years, and adopting new technologies is a trend on the rise. AI in healthcare has significant potential, on a wide range of intelligent solutions, from mobile coaching solutions to drug discovery, everything gets easier with machine learning capabilities.

In a world where information is key to having access to affordable and efficient healthcare, understanding what one’s health plan is covering is key to getting the care one needs.

Research points to the fact that patients 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. With seniors and especially undocumented seniors most likely to not get any health care due to costs and lack of informations, the decision to provide this category of public health insurance made Illinois the 1st state to do so, amid the pandemic crisis. 

What will the partnership provide to help patients? 

Watson Assistant for Health Benefits aims to keep patients better informed by leveraging conversational AI to ease the engagements between agents, employers, and Humana Employer Group members, by facilitating access to clear and accurate information regarding benefits, healthcare costs and providers.

As part of the agreement, Humana will deploy IBM Watson Assistant for Health Benefits, an AI-enabled virtual assistant built in the IBM Watson Health cloud. At first, 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 offers fast, correct, and helpful information using a conversational virtual assistant with member benefits, coverage, claims, referrals, and healthcare costs for Humana Employer Group members, agents, and employer-customers. The aim is to create a cloud-native AI platform powered by IBM Watson with the conversational AI virtual assistant solution.

“Humana is excited to team up with IBM Watson Health to help our employer-customers and their employees better manage their healthcare benefits and costs through a more innovative, personalized experience,” said Chris Hunter, Segment President of Humana’s Group and Military Business. “At Humana, we strive to use technology to better serve our members with simple and convenient healthcare experiences. By harnessing the power of artificial intelligence fused with embedded analytics in the Watson Health platform, we can help our employer-customers, members, agents, and broker partners enhance their knowledge so they can all make more informed decisions.”

How will the Watson Assistant for Health Benefits work 

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 IBM 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.

Humana is continuously forming partnerships to provide better care solutions

Humana is not at its first collaboration for better healthcare support. Back in 2018, it was working with Walgreens, in order to form a partnership between the two companies, following the setting up of a pilot program that saw the opening of two senior-focused care centers in existing Walgreens stores in Kansas City, Missouri, to serve Medicare patients. The partnership provided in-person primary care, pharmacy services and health plan guidance. The idea behind the clinics was that they should go beyond checkups and appointments and instead focus on building relationships with patients, helping them manage chronic conditions, and understand their health plan benefits.

The current project is just as important to the current partner, IBM Watson Health, as it is to Humana. 

“Navigating our health coverage without the right support can potentially serve as a barrier to care. An AI-enabled conversational agent that is trained to understand health plan benefits logic can play a role in helping to simplify complex or possibly confusing plan information,” said Paul Roma, General Manager, IBM Watson Health. “We are proud to support Humana in leading the effort to deploy conversational AI to help enhance and improve the consumer experience.”

This collaboration comes two years after IBM Watson Health announced it plans to make a 10-year, $50 million investment in research collaborations with two separate academic centers – Brigham and Women’s Hospital and Vanderbilt University Medical Center –  to advance the science of artificial intelligence (AI) and its application to major public health issues.

About Humana

Humana Inc. is committed to helping our millions of medical and specialty members achieve their best health. Our successful history in care delivery and health plan administration is helping us create a new kind of integrated care with the power to improve health and well-being and lower costs. Our efforts are leading to a better quality of life for people with Medicare, families, individuals, military service personnel, and communities at large.

About IBM Watson Health

IBM Watson Health is a data, analytics, and technology partner for the health industry. Supported by the innovation of IBM and the intelligence of Watson, we are committed to helping build smarter health ecosystems. Through the combination of our deep industry expertise in health, data and analytics, actionable insights, and reputation for security and trust, Watson Health is working together with its clients and partners to help them achieve simpler processes, better care insights, faster breakthroughs, and improved experiences for people around the world. 

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