Humana taps IBM Watson to enhance the member experience for Humana Employer Group customers

The AI-enabled Watson virtual agent can help enable greater access to accurate and helpful information about benefits and healthcare costs.

IBM Watson Chatbot

Humana and IBM Watson Health announced a collaboration leveraging IBM’s conversational 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.

Why does it matter?

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. 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 virtual assistant 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 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.

On the record

“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.”

“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.”

The context

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 to streamline the engagements between agents, employers, and Humana Employer Group members with clear and accurate information on benefits, healthcare costs and providers.