Humana Aims To Streamline Services With AI
by Elisha Moskel Talent Management ServicesFrontline healthcare employees — nurses, call center agents, among others — have one of the toughest jobs in America.
They
help patients navigate a complex healthcare system, while juggling
hundreds of menial tasks. It can be a difficult and frustrating role.
With
45,000 associates serving over 14 million members, health insurer
Humana uses artificial intelligence and robotic processes to assist the
daily routine of their associates making healthcare easier for clients
to access.
“Humana made a conscious decision to use digital
innovation to help our associates deliver a better healthcare experience
our members,” said Alexis Paul, director of intelligent and robotic process automation.
Call Center Experience
Humana
members call for many reasons: understanding a claim status, inquiring
about benefits eligibility, placing orders for new or re-filled
prescriptions or appealing a medical coverage decision.
The answers to these questions are stored in different information systems. The company uses artificial intelligence and intelligent automation to help bridge gaps between systems. The aim is a better call experience.
“Whether
a member calls about their medication or claim, we have a bot, or what
we call ‘digital worker’ actively helping the associate serve the
member during the call,” said Paul. “ We are able to answer the question
so much more quickly”.
Humana is looking at bringing together
different components of machine learning and automation that are already
available into a single tool.
Paul said, “Humana’s use of
natural language processing, machine learning and robotic process
automation allows their associates to have information instantly at
their fingertips across multiple systems.”
She added that
Humana looks at how one process like claims integrating with many
business functions and systems can be turned into one experience for
Humana’s associates. The result being that anyone who handles the claim
process can handle many parts of the member’s request without having to
transfer a call.
The company is testing how digital workers
can look ahead to pull and highlight information from a medical report
when the system hears certain keywords in a conversation between a
member and an associate.
Members’ appeal requests for denied
service present a challenge for an associate. Generally speaking,
members with grievances and appeals want Humana to listen and make a
change.
“We deployed cognitive digital workers to improve the
process for routing requests associated with the initial grievance and
appeals call,” said Paul. “We are seeing real improvements in case
handling times as well empowering our associates to make better and
faster decisions.”
Cognitive digital worker means that using
machine learning, the digital worker presents options to the associate
beyond just automating a repetitive task.
Humana is
experimenting with sentiment analysis and natural language processing
analyzing the transcripts from appeals calls. The company is learning
the specific vocabulary model, patterns and sentiment from Humana
members in the past. In the future, the company may be able to present
more creative solutions to members based on the machine learning from
past case history.
Automation Fast Tracks Results
About
three years ago, Humana formed the intelligent and robotic process
automation task force. The team’s mission is to automate the cross
functional and independent desktop processes using intelligent
automation, artificial intelligence, and natural language processing.
It
is a common trend among large companies such as HPE, Deutsche Bank, and
Fiserv to fast track their artificial intelligence and automation
journey with focused task force of artificial intelligence and
automation experts.
Much like their peer companies, Humana uses
off-the-shelf products as well as homegrown systems. They chose
Automation Anywhere for their desktop automation service and Workfusion
for their intelligent automation software.
Automation Anywhere
automates the many repetitive swivel-chair tasks in the organization,
think of all the constant work employees do to pull data off one screen
and key it in another. And it allows the business units business teams
to write their own screen automations rather than needing to call IT.
Humana
picked WorkFusion to automate tasks with unstructured data using
natural language processing. Unstructured data means any textual data
that comes from a paper document, electronic document like a PDF file or
email message. Forbes reported in 2017 that over 80% of the data
within an organization is unstructured. So, the heavy lifting behind the
scenes happens on the unstructured data side.
Paul said, “How
does one extract information and make decisions on messy fax forms and
on medical records which arrive in a thousand different formats? We
use the natural language processing and machine learning capabilities of
the WorkFusion tool to make this happen.”
She also added that
Humana implemented innovation on the desktop years ago with two helper
apps making it seamless for an associate to sign on and share
information across multiple systems. Those desktop apps are still in use
as well as several other apps that we are deploying.
“We treat automation like a product with every product having a purpose and life cycle,” said Paul.
Humana’s Digital Health & Analytics
When
the automation team needs solutions-specific healthcare data analytics,
algorithms, or creative digital experiences, they turn to Humana’s
Digital Health & Analytics team.
The company organized the
Digital Health & Analytics team in 2018 to bring together agile
development, consumer design, analytics capability and data scientists
to focus on digital transformation and digital enablement.
The
Digital Health & Analytics team uses natural language processing
and artificial intelligence to produce insights on Humana’ vast ocean of
data. The automation team uses the outputs and trends from the Digital
Health and Analytics team to augment robotic process automations.
Over
time, this will expand the types of cognitive automation tasks that can
be implemented, moving beyond what is possible today with regards to
information extraction and classification.
Building Citizen Developers
Humana
made a big push to turn their associates into citizen developers. A
citizen developer is a new term used to describe non-programmers using
artificial intelligence and automation tools to build programs.
“When
we kicked off automation three years ago, we made a conscious effort to
select tools that our associates could use to automate the redundant,
boring tasks in their work,” said Kerry Wang, intelligent automation
center of excellence leader. “We identify and train those associates
who want to be citizen-developers.”
Tools such as Workfusion and Automation Anywhere allow Humana’s associates to take control of their personal job productivity.
The
automation center of excellence taskforce launched a citizen developer
program that uses Automation Anywhere to allow associates to identify
and automate simple day-to-day tasks. The program provides training,
code reviews and guidance on automation.
In late 2019, the
healthcare services division with trained associatites built and
deployed over 35 automations over a three month period — citizen
developers at work. Humana’s associates delivered complex software to
automate their jobs in a fraction of the time that the IT team would
normally do.
What Humana Learned So Far
Humana learned
that the training, supervision, and maintenance of their digital
workers mirrors that of their human colleagues. The push to
decentralize decisions to their associates is delivering meaningful
results for the company.
This was possible in part because the
company fast tracked and invested in their digital journey. They set up
the organization necessary to scale artificial intelligence across the
company.
“People who were doing mundane repeatable tasks before
now have become a manager of the digital workers, managing teams and
generating exponentially more throughput than they could alone,’ said
Paul. “Behind the scenes, Humana has a significant platform of people,
software, and processes enabling artificial intelligence and automation
to succeed.”
She added the automation and digital health and
analytics teams are a few of the many initiatives inside Human using
technology innovation to deliver a better healthcare experience.
Humana’s
members have easier access to their healthcare services at a reduced
cost to the company. Beyond productivity gains, Humana’s associates
have fewer menial tasks and more decision power in their daily work
routines.
Most interesting, Humana adds a new cool factor to
their work culture by giving employees the opportunity to be
citizen-developers who build cutting edge healthcare services using
artificial intelligence and automation.
This Article Source is
From
https://www.forbes.com/sites/neiledwards/2020/03/02/why-doesnt-your-healthcare-insurer-use-ai-like-humana-does/#5147299e608e
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Created on Mar 5th 2020 06:21. Viewed 524 times.