How conversational AI helps healthcare payors transform member engagement

Many Medicare plans saw lower Star ratings this year. That’s partly because the Centers for Medicare & Medicaid Services (CMS) adjusted its methodology to focus more on member experience-related metrics. But it’s also a clear indication that members now expect better service and engagement from payors—in every channel. 

With member satisfaction scores declining and healthcare consumerism rising, payors that can offer simple, seamless, and secure omnichannel experiences will gain a significant competitive advantage. Those that can go further and deliver the personalized, proactive experiences members expect will be well positioned to maintain 5-star performance long into the future. But without cloud-based conversational AI, creating intelligent, connected member experiences is extremely difficult. 

By bringing intelligence to the contact center, payors can add a huge amount of value for members. They can enable members to engage in any channel at any time. They can give agents the tools and insights to offer effective guidance and resolve issues quickly. And they can make it easier for members to navigate even the most complex healthcare journeys—helping to improve outcomes and reduce care costs. 

Transform member engagement with automation 

Automation is the key to delivering seamless and convenient omnichannel engagement. With Nuance conversational AI solutions on the Microsoft Digital Contact Center Platform, payors can provide connected self-service experiences across all engagement channels.  

Intelligent virtual assistants in digital channels and conversational IVR systems in the voice channel can quickly resolve common member inquiries without needing to involve an agent. When cases do need to be escalated to a live agent, intelligent routing ensures members reach the most appropriate agent the first time. And contextual transfer gives agents all the context of the conversation, along with other relevant member insights, so members don’t have to repeat themselves—even if they change channels during a conversation. 

For example, when leading healthcare payor Humana deployed a Nuance IVR to reduce the need for agent transfers, the Net Promoter Score for its IVR rose by 80%, and it beat its self-service target by 325%. With results like these, it’s no surprise that Humana has numerous 5-Star plans in Medicare Advantage Star Ratings for 2023

AI-powered automation also enables payors to engage members proactively. By automatically sending important care plan reminders and information in each member’s channel of choice—and letting them respond in the same channel—payors make it much simpler for members to manage their care. 

Empower contact center agents 

For those interactions that can’t or shouldn’t be automated, agents must be equipped to resolve inquiries efficiently and effectively. Conversational AI helps here too, empowering agents to become more productive and deliver outstanding service.  

Nuance Agent Coach gives agents real-time member insights, best practice guidance, next best action recommendations, and compliance reminders, so they can resolve inquiries quickly and become trusted member advocates. Members get the fast, effective support they expect, and agents feel empowered and confident, helping increase job satisfaction and reduce churn.  

Personalize and optimize member interactions 

Whether member experiences are automated or human-assisted, personalization is essential to meet modern consumer expectations. By securely connecting engagement insights, CRM data, and electronic health record (EHR) information on the Microsoft Digital Contact Center Platform, payors can get a complete picture of each member and their healthcare journey to support personalized experiences. 

This 360-degree view also plays an important role in improving member engagement. By analyzing data from every member interaction on every channel, payors can identify friction points and optimization opportunities across the entire member journey. 

Bring intelligence to your contact center with conversational AI 

With a comprehensive suite of AI-driven capabilities—all on a single platform—payors can quickly make big strides forward in their contact center transformations. Member expectations will continue to grow, but by creating and optimizing intelligent omnichannel experiences on the Microsoft Digital Contact Center Platform, payors can attract and retain more members while driving new operational efficiencies.  

To begin plotting your path to contact center transformation, learn more about the Microsoft Digital Contact Center Platform and explore more conversational AI resources for payors

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Tony Lorentzen
About Tony Lorentzen

Tony has more than 25 years of experience in the technology sector, spending the last 17 with Nuance where he is currently the SVP of Intelligent Engagement Solutions within the Enterprise Division. Before that he served as the leader of several teams at Nuance including Sales Engineering, Business Consulting, and Product Management. A proven leader in working with the cross-functional teams, Tony blends his in-depth knowledge of business management, technology and vertical domain expertise to bring Nuance’s solutions to the Enterprise market, partnering with customers to ensure implementations drive true ROI. Prior to Nuance, Tony spent time at Lucent and Verizon where he led teams that applied the latest technologies to solve complex business issues for large enterprises. Tony received a B.S. from Villanova University and a MBA from Dowling College.