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Digital Business
AI at Your Service: Modernizing
the Payer Contact Center
Here’s how AI will enhance the consumer experience
across health plan contact center touchpoints.
Executive Summary
Digitally adept companies, such as Amazon and Uber,
are elevating consumer demands for convenient,
personalized and intelligent experiences. Artificial
intelligence (AI) and its related technologies — analytics,
intelligent process automation (IPA), machine learning
(ML) and natural language processing (NLP) — are
the engines driving these experiences. AI has become
critically important for players in the healthcare sector, as
it helps increase business value through contact center
operations by converting data into meaningful insights
that enhance consumer interactions.
At a foundational level, AI streamlines processes, freeing
contact center associates to focus on higher value
consumer interactions. As AI matures, it will transform
consumer experiences by delivering real-time insights
that enable payers to anticipate and proactively resolve
consumer issues.
Whether through a software bot that makes simple
yes/no rules-based decisions or an algorithm that sifts
through data patterns to find at-risk members, AI first
creates, then continuously layers, details and insights
onto portraits of health plan members. As a member
profile grows richer over time, AI tools draw on details
Cognizant 20-20 Insights
December 2019
such as health status, claims history, shifting
demographics and so on to recommend actions
and forecast member-specific needs. Equipped
with these insights, payers can respond quickly and
appropriately to changing member needs, build
brand loyalty and expand payer revenue channels.
Today, AI tools enable payers to quickly and cost-
effectively deploy new capabilities and create
a foundation for modern member experiences.
Payers that leverage AI in their contact centers can
gain an early lead in differentiating their services
and building sustainable, value generating, lifetime
member relationships.
In this white paper, we will help payers understand
the benefits and opportunities as they embark on
their AI journey by addressing:
❙❙ How is AI essential for attracting and retaining
members?
❙❙ How can AI enable better and more actionable
insights with higher precision?
❙❙ Where should payers start and how can they
accelerate their AI transformation journeys?
Cognizant 20-20 Insights
2  /  AI at Your Service: Modernizing the Payer Contact Center
Cognizant 20-20 Insights
3  /  AI at Your Service: Modernizing the Payer Contact Center
Cognizant 20-20 Insights
AI: Essential to delivering modern member experiences
Members rate their health plan service experiences
as “okay” at best (see Figure 1).
1
Further, a third of
plan members say they will switch health plans
after a bad service experience.
2
With a member’s
lifetime value estimated at $1.4 million, bad
experiences can result in significant losses.
3
Based on our observations, many payers have
increased their investments in digital tools and
contact center technologies, but have yet to
realize the desired improvements. It’s likely that
these payers have not fully analyzed their member
journeys and considered their expectations when
designing tools or they have not invested sufficient
resources in member digital-tool adoption
campaigns.
4
Base: 10,000 U.S. Consumers
Source: Temkin Group Q1 2018 Consumer Benchmark Survey
Figure 1
Healthcare is lagging...
2018 Temkin Experience Ratings (TxR), Range of Industry Scores
Very Poor Poor Okay Good Excellent
Low Score Industry Average High Score
50% 60% 70% 80%
Fast Food Chains
Retailers
Banks
Parcel Delivery
Streaming Media
Hotels & Rooms
Credit Cards
Investment Firms
Insurance Carriers
TV & Appliances
Wireless Carriers
Auto Dealers
Airlines
Computers & Tablets
Utilities
Software Firms
Rental Cars & Transport
Supermarket Chains
TV/Internet Services
Health Plans
Cognizant 20-20 Insights
4  /  AI at Your Service: Modernizing the Payer Contact Center
Evolving consumer needs and preferences
require payers to reimagine their relationship
with members. It’s no longer “business as usual.”
Understanding a member’s claim history,
medications and other details alone is not
enough. Payers must think further ahead into their
member’s journey and identify areas where they
can proactively help manage care needs and lead a
healthy lifestyle (see Figure 2).
AI tools are essential to meet these new and ever-
expanding member expectations. Only AI can help
keep pace with and make sense of the petabytes
of data generated through member interactions,
wearable devices and other inputs. As AI tools
create insights, payers can use these insights to
improve consumer experiences and transform the
contact center into a profit center. Let’s look at a
few other industries that are embracing the power
of AI in their contact centers to generate profitable
growth:
❙❙ The online retailer Asos used a chatbot to
interact with customers and make appointments
for fashion makeovers. As a result, appointments
rose 11%, order volume via chat increased by
300% and return on spend grew 250% while the
company reached 3.5 times more prospective
customers.
5
Today’s health plan members demand more personalized, “warm” experiences that reflect their unique needs and situations.
Delivering these experiences requires payers to rethink the contact center, equipping it to become an opportunity center
that drives member loyalty and enhances their lifetime value.
Figure 2
Consumers demand service their way
On time availability
Good communication skills
Resolving problems, providing advice,
administering sales
Cost center
Operational, cost
Reactive, scripted, controlling
24x7 support across omnichannel
social media integration
Warm care, empathy, self service and
readiness to listen
Driving positive experience and
lifetime loyalty
Opportunity center
Customer, experience
Proactive, collaborative, unique
Expectations change from... to...
5  /  AI at Your Service: Modernizing the Payer Contact Center
Cognizant 20-20 Insights
Within healthcare’s compliance boundaries, AI use in contact
centers offers extensive opportunities. Vitally, payers must
understand that their AI end game should aim to create
comprehensive, insight-filled member portraits.
❙❙ Amazon uses deep learning to personalize
recommendations at nearly every step of its
customers’ journeys on category, product and
checkout pages. About 70% of Amazon’s screen
real estate supports recommendations, which
drive a third of its revenue.
6
❙❙ At CenturyLink, an AI-driven assistant handles
about 30,000 customer emails monthly and
analyzes responses to identify important leads
to route to appropriate departments. With 99%
of emails correctly processed, company sale
representatives have more time to focus on and
follow up with high-value cases.
7
Across healthcare, more companies are adopting
AI, especially in areas that improve the overall
consumer experience:
❙❙ Pager, a digitally native company, uses ML to
analyze clinical and claims data to discover gaps
in a patient’s treatment, make recommendations
and help patients schedule appointments.
8
❙❙ zakipoint Health automates the task of
displaying relevant healthcare data to members
via a dashboard that improves engagement and
healthy behavior adoption to better support cost
containment.
9
❙❙ Several large payers such as Aetna analyze the
emotional sentiment of call center conversations
using NLP. Sentiment analysis helps them
understand the caller’s intent to help improve
the customer experience and agent training.
10
❙❙ Anthem is partnering with health research firm
doc.ai to explore how AI can be used to predict
when people will experience allergies or allergy
patterns.
11
❙❙ Aetna, in collaboration with Apple, launched
a new health app to provide users with
personalized health goals. Aetna’s new Attain
app allows Apple Watch users to track daily
activity levels, receive recommended healthy
actions, improve nutrition and aid sleep habits.
12
Within healthcare’s compliance boundaries, AI use
in contact centers offers extensive opportunities.
Vitally, payers must understand that their AI
end game should aim to create comprehensive,
insight-filled member portraits. Without this
objective, payers may deploy AI apps that do not
necessarily contribute to a long-term ROI strategy.
Understanding the current limits and future
capabilities of AI and how to best leverage it will
help payers quickly deploy AI with purpose and
direction to enhance the member experience and
develop sustainable new revenue streams.
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The AI maturity continuum: Building a hyper-
personalized ‘member portrait’
AI technologies transcend a range of capabilities
across the maturity continuum, from software bots
that make simple decisions to highly sophisticated
algorithms that proactively identify and address
emerging issues (see Figure 3). Member data is
captured at every point along this continuum, which
feeds a comprehensive member portrait. Member-
specific data may include details related to claims
and health history, clinical insights, provider notes,
communications channel preferences, financial
details, sentiments during different interactions,
medication adherence, and responses to different
plan and wellness offerings. This data should be
assigned to appropriate member portrait categories.
AI technologies leverage these data points to
augment and support human agents during
interactions with members and, in many cases, can
initiate member engagements proactively based on
the data-driven insights.
Most organizations start their AI journey by
automating rote processes and creating rules
engines that streamline and optimize contact
center workflows and processes. These efforts
may include deploying virtual assistants that can
execute simple tasks such as pulling up benefits
for website visitors; rules to automate call routing;
and interactive voice response (IVR) systems that
leverage NLP. As AI technology matures, cognitive
AI tools at all maturity levels can enable payers to build in-depth member portraits. AI-based systems continually draw on and
add layers to these portraits to help contact-center agents deliver personalized services.
Figure 3
The AI capabilities maturity continuum
Guide with next
best actions.
Cognitive search
to provide help to
resolve member
and provider
issues and queries.
Proactive &
personalized lifestyle
and wellness insights.
Augment self-
service tools with
improved provider,
benefit, claims and
member data.
Customer speech
& sentiment
analysis.
Claims adjustment
insights; intelligent
appeals and grievances
management.
Interaction tracking
and experience
management.
Establish member &
provider 360-degree
view across all
interaction points.
Complaints
classification &
routing to avoid
regulatory fines.
Personalized
reminders for
healthcare actions.
Augmented sales
support with
personalized offers.
Process
improvement,
and new workflows
within existing
systems.
Deploying new
data, analytics
and technology
capabilities.
Applying ongoing
insight with the
context and user
preference in mind
(e.g., time, location).
Creating an
intuitive, consistent
omnichannel &
seamless service
experience.
Embedding new
tools that help to
navigate the
healthcare
ecosystem.
Utilizing member
data to proactively
provide personal-
ized services.
Optimization Modernization Self-service Navigation Advocacy Empowerment
Cognizant 20-20 Insights
7  /  AI at Your Service: Modernizing the Payer Contact Center
search tools will help members resolve queries
themselves. Payers should focus on programs that
enable greater customer self-service. For such, it’s
essential to capture and understand every detail
in the member’s portrait and use the right tools
and channels based on unique member situations.
As an example, a member who inquires about a
provider address or benefit detail for an annual
checkup can be directed to self-service tools,
but a member requiring details for a close family
member’s critical care related to a recent surgery
should gain immediate access to a contact center
agent to receive warm, empathetic care.
AI should continuously analyze new data as
it’s added to the member portrait. Further, AI
augmented with ML algorithms can learn member
preferences, at both individual and aggregate
levels. This capacity enables the system to predict
member needs, such as applying self-service
options for a simple inquiry or providing detailed
advice about plan options, health choices and
general wellness.
AI tools also can predict member adherence and
acceptance to outreach and care management
programs and, thereby, recommend optimal
engagement tactics and channels, and
identify members who might require proactive
interventions. Additionally, AI-based sentiment
analysis can predict a member’s temperament
and prepare an appropriate response, such
as immediately connecting a member who
has a chronic condition to a live agent. AI can
also recognize when a member’s lifestyle or
circumstances change and recommend plans and
services that meet emerging needs.
Here’s one common scenario that demonstrates
how AI-based tools support member needs: A
plan member’s son is turning 26 and soon will no
longer be covered under his parent’s policy. At the
least mature end of the AI spectrum, a software bot
could automatically send an email to the parents
to note the coming change in their premium.
A more advanced bot might push promotional
material to the son via his preferred channel. At the
highest maturity level, an AI-based solution would
identify the son as a potential prospect before he
ages out and ensure there is a focused marketing
effort to have him continue with the health plan
after age-out. Mature AI capabilities can ensure
the target member receives the right type of
plan recommendations that leverage the right
interaction channel based on their unique member
portrait developed over time.
AI should continuously analyze new data as
it’s added to the member portrait. Further,
AI augmented with ML algorithms can learn
member preferences, at both individual and
aggregate levels.
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8  /  AI at Your Service: Modernizing the Payer Contact Center
Payers can deliver compelling member experiences while achieving significant cost savings by augmenting customer service
representatives and business processes with more mature AI capabilities.
Figure 4
Service experience can be transformed with AI
Optimizes existing manual and
fragmented processes.
Frees the workforce from simple
repetitive tasks — but human
intervention is required.
Robotic Desktop Automation
(RDA)
Process: standard/rule-based.
Information: structured.
Automates rule-based processes.
Also, makes cleansed data from
various sources accessible to AI
platform.
Unassisted automation.
Robotic Process Automation
(RPA)
Process: standard/nonstandard.
Information: structured/unstructured.
Makes human-like judgmental decisions,
based on training and historical data using AI.
ML technology to handle complex exceptions.
AI-Powered Business Processes
Level1
Level2
Level3
Robotic Desktop Automation
Robotic Process Automation
AI Powered Automation
Cost savings
~up to 5%
Cost savings
+25%
Cost savings
+50%
+
Organizations are moving from level
2 to level 3 to increase operational
efficiency and reduce costs.
AI use cases for payers
Most payers have vast stores of member data. By
applying AI tools to these resources and creating
member portraits, payers can glean insights that
help them operate more efficiently and improve
member experiences (see Figure 4).
To begin, payers may use existing member data to
create a baseline member portrait and continuously
add additional insights from incoming streams
of data for the same member. Gradually, a robust
member portrait will emerge.
Continual additions of data help enhance
the portrait with increased precision and
personalization. Deep insights about individual
members can be derived by analyzing member
portraits. By identifying common patterns across
individual member portraits, payers can isolate
critical high-priority issues for quick wins.
Here are a few examples of potential AI-enabled
service enhancements around the member
portrait:
❙❙ Member self-service options: Develop and
show personalized content based on history
and context. Improve and customize search
functionality – e.g., focus on content aligned with
the member’s context and portrait.
❙❙ Agent augmentation: Enhance the experience
by using AI to provide the agent with a complete
member portrait along with their contextual
information. For example, AI can help agents
proactively call the member or predict the
reason for a call based on the time of year,
call location, past medication needs, family
medication history, recent claims or individual
preferences.
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9  /  AI at Your Service: Modernizing the Payer Contact Center
❙❙ Member advocate: AI supports member needs
and helps proactively identify problem areas,
challenges and opportunities, and ensures the
payer responds in a manner that delights the
member. For example, using the member’s
history, the system can identify additional
tests needed as part of their annual check-up,
schedule additional specialist appointments, and
auto-generate and approve pre-authorizations
for tests if needed.
Payers may also develop innovative new member
services built on the AI-driven contact center
capabilities. Health plan members told us they are
willing to share digital data from their wearables and
home monitoring devices with payers in return for
customized advice and incentives.
13
AI could use
that data to glean more insights about community
and population health issues as well as develop
personalized analyses for members.
Payers should be mindful that as AI matures and
becomes more proactive, they will need to ensure
their AI-based tools are responsible and ethical (see
Quick Take, page 11).
Getting started
For our clients, we advise a “10-10-10” approach
to guide the adoption of AI capabilities in contact
centers:
10 Days
❙❙ Define what AI means to the organization with
respect to contact center enhancements.
>> AI is not a technology play. While AI
technology is an enabler, its implementation
must be business driven. Successful
implementation in the contact center
requires process redesign championed by
business leaders.
>> Get leadership buy-in and support of
the AI value propositions, which should
include projected cost reductions through
operational and experience improvements.
❙❙ Identify and plan a minimum viable product or
proof of concept.
>> Identify and assess AI opportunities across
applications, infrastructure and security
operations to define the target state. Specific
AI examples include AI-powered IVR,
automated routing and automated agent
guidance. Promote overall contact center
efficiency and effectiveness by having agents
focus on delivering warm, empathetic care
that results in a truly differentiated member
experience.
>> Analyze functional and technical
requirements to attain a best-fit approach for
the AI-powered layer.
>> Assess AI algorithms to ensure automation
and learnings align with business goals.
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10  /  AI at Your Service: Modernizing the Payer Contact Center
10 Weeks
❙❙ Implement a minimum viable product.
>> Establish an agile team comprising business
and technical resources.
>> Design and develop the minimum viable
product.
>> Garner feedback from the user community
and optimize the AI algorithm.
>> Fine-tune the overall implementation
approach and roadmap based on the lessons
learned.
>> Leverage the lessons learned to inform the
overall AI strategy.
❙❙ Define an enterprise-wide contact center AI
strategy.
>> Consider adopting an AI-first mindset, which
requires using AI to solve business problems
wherever applicable and possible.
>> Move from piecemeal AI-oriented efforts
to a mainstream, dedicated and executive-
sponsored effort to drive AI.
>> Define a strategy that will address business
challenges. Identify capabilities needed to
develop in-depth member portraits that can
improve the member experience.
❙❙ Define a high-level two to three year roadmap
for contact-center-focused AI capabilities.
>> Quantify automation and AI benefits,
develop a roadmap and calculate high-level
ROI. Socialize with and obtain buy-in from
business stakeholders.
10 Months
❙❙ Develop a comprehensive operating model to
operationalize AI.
>> Analyze the impact of AI capabilities across
people, processes and technologies.
>> Establish an AI center of excellence to drive
AI best practices across the organization and
establish governance standards, noting that
most large organizations must accommodate
some level of customization.
>> Conduct skills assessment within the current
workforce and retrain, hire or source the right
skills.
>> Design the right incentives to drive AI
adoption across the organization.
❙❙ Continue to implement the AI capabilities that
have the most member and business impact,
and continuously incorporate the learnings from
new use-case implementations into the overall
strategy.
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11  /  AI at Your Service: Modernizing the Payer Contact Center
Ensuring Strong Ethics for
Effective Contact Center AI
According to our recent multi-industry AI study, only about half of the respondents said
their companies have policies and procedures in place to identify and address ethical
considerations in their AI applications.
14
Healthcare executives must be part of this group of early ethics adopters because so many
AI-based decisions will affect what and how care is delivered. Ethical policies, procedures
and governance programs are critical to successful AI applications, and should be a chief
concern across the healthcare industry. Members, patients and payer employees should be
served through AI that is responsible and ethical. For example, an AI agent that suggests
a new service for a member who just received bad health news should be sensitive to
the member’s status. Although the AI might present the offer as a logical response to a
change in health status, the member might find the communication or offer manipulative
or intrusive. Payers need to think through these scenarios as part of a broad AI ethics and
responsibility strategy that incorporates the following:
❙❙ Governance: AI’s effective use requires ongoing input, support and review throughout
the payer organization. With governance mechanisms in place, payers should be
prepared to cease or reconfigure an AI initiative that’s showing unwanted results.
>> A chief AI ethicist: As part of a strong governance program, this role would be
responsible for the actions and outcomes of decisions made with or augmented
by AI.
❙❙ Control for bias in AI: Businesses must understand the typical types of bias that can
creep into AI system design and ongoing operations without proper controls.
15
First,
there’s bias that stems from the data used to train the system. If the data is biased or
used out of context, the resulting outcomes also will be biased. Organizations must also
account for unconscious bias by employees who create the AI systems. Humans tend
to reflect their own experiences and beliefs, so teams lacking diverse perspectives may
create a biased program. Finally, bias can be propagated by self-learning AI systems that
Quick Take
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12  /  AI at Your Service: Modernizing the Payer Contact Center
work with biased data or come to conclusions based on biased data or processes. It is
very important to have a rigorous quality assurance program that addresses these biases
and removes them through iterations.
❙❙ Transparency: As AI-based solutions learn, it often becomes increasingly unclear
how the algorithms within them are evolving, so that they are likened to a “black box.”
Members and providers are unlikely to accept AI-based decisions if payers can’t explain
how the AI agent arrived at them. Payers should work closely with their service providers
to ensure visibility into how its algorithms work.
16
It is also important to model these
algorithms with high volumes of data in test environments, and continuously monitor
the results and modify the algorithms as needed over time.
❙❙ A plan for unintended consequences: When designing AI systems, organizations must
recognize that people likely will behave differently if they know they’re interacting with
an AI system. For example, a member unlikely to berate a human customer service agent
might otherwise scream at a chatbot. A few might do so to game the system.
17
Another reason why payers and their service providers must build AI applications on a
strong ethical foundation: As AI systems proliferate, they will be taught by other AI systems.
If unchecked, an unethical AI system will propagate its biases and other issues, negating
any positive impact. Ultimately, humans are responsible for controlling the behavior of their
AI systems and ensuring they achieve desired and ethical outcomes that are consistent
with the payer’s values and member priorities.
Quick Take
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Endnotes
1	 Temkin, Bruce, 2018 Temkin Experience Ratings, Qualtrics XM Institute, March 2018,
www.qualtrics.com/docs/xmi/XMI_TemkinExperienceRatings-2018.pdf
2	 Shea, William; Shrimali, Shashi; Kama, Carolyne, “Extending the Case for Digital: Health Plan Members Speak,” 2018,
Cognizant, www.cognizant.com/whitepapers/extending-the-case-for-digital-health-plan-members-speak-codex3814.pdf
3	 Wynne, Brian, “The real reason loyalty lacks in healthcare,” May 2, 2018, Becker’s Hospital Review, www.
beckershospitalreview.com/population-health/the-real-reason-loyalty-lacks-in-healthcare.html
4	 Shea, William, “Why haven’t health plan members adopted digital tools? Hint: it’s probably the tools, DigitallyCognizant,
https://digitally.cognizant.com/why-havent-health-plan-members-adopted-digital-tools-hint-its-probably-the-tools-
codex3953/
5	 Kojouharov, Stefan, “How Businesses are Winning with Chatbots & AI,” Jan. 24, 2018,
https://chatbotslife.com/how-businesses-are-winning-with-chatbots-ai-5df2f6304f81
6	 Schneider, Gene, “Learning from Amazon’s embrace of personalization, by Gene Schneider | March 6, 2018, SPS
Commerce Inc. www.spscommerce.com/blog/amazon-embraces-personalization-spsa/
7	 Power, Brad, “How AI Is Streamlining Marketing and Sales,” June 12, 2017, Harvard Business Review,
https://hbr.org/2017/06/how-ai-is-streamlining-marketing-and-sales
8	 https://pager.com
9	 https://zakipointhealth.com/z5-platform-2/
10	 “This Call May be Monitored to Help Us Help You,” HBS Digital Initiative, April 9, 2018,
https://digital.hbs.edu/platform-digit/submission/this-call-may-be-monitored-to-help-us-help-you/
11	 Townsend, Tess, “Anthem thinks its ‘virtuous cycle’ with doc.ai can improve patient care,” Venture Beat, July 11, 2019,
https://venturebeat.com/2019/07/11/anthem-thinks-its-virtuous-cycle-with-doc-ai-can-improve-patient-care/
12	 Thakar, Subrata, “Aetna, Apple launch AI-based app to achieve personal health goals,” HealthExec, Jan. 29, 2019,
www.healthexec.com/topics/health-it/aetna-apple-launch-ai-based-app
13	 Shea, William; Shrimali, Shashi; Kama, Carolyne, “Extending the Case for Digital: Health Plan Members Speak,” 2018,
Cognizant, www.cognizant.com/whitepapers/extending-the-case-for-digital-health-plan-members-speak-codex3814.pdf
14	 Ramaswamy, Poornima, Jeude, James, Smith, Jerry A., “Making AI Responsible—and Effective,”
www.cognizant.com/whitepapers/making-ai-responsible-and-effective-codex3974.pdf
15	 Ramaswamy, Poornima, “The Road to AI,” www.cognizant.com/whitepapers/the-road-to-ai-codex3614.pdf
16	 Cohen, Jessica Kim, “Liability concerns may pose roadblock for hospital AI, “ Modern Healthcare
www.modernhealthcare.com/technology/liability-concerns-may-pose-roadblock-hospital-ai
17	 Smith, Jerry; Ramaswamy, Poornima; Jeude, James, “Eight Ways to Forge a Path to Real and Responsible AI,”
https://digitally.cognizant.com/eight-ways-to-realize-real-and-responsible-ai-codex4304/
Acknowledgments
The authors would like to thank the following Cognizant personnel for their invaluable contributions
to this paper:
❙❙ Sudhir Dutt, Manager of Consulting
❙❙ Illamathy Erode Nallasamy, Senior Consultant
❙❙ Aman Preet , Senior Consultant
❙❙ Harsh Kulkarni, Business Analyst
❙❙ Vikram Shankar, Business Analyst
❙❙ Shwetana Sunkari, Consultant
❙❙ Ishita Malhi, Business Analyst
Cognizant 20-20 Insights
14  /  AI at Your Service: Modernizing the Payer Contact Center
About the authors
Nikhil Sarathi
Consulting Partner and Global Lead for Consumerism, Cognizant Consulting
Nikhil Sarathi is an Assistant Vice President within Cognizant Consulting’s Healthcare Practice. He has
over 18 years of experience in healthcare and technology, and has a strong track record of success in
consumer-centric strategies, next-generation capabilities identification and implementation, leading large
digital transformation programs and evaluating partnership models for healthcare organizations. Nikhil
specializes in the areas of strategy development and execution, platform strategies, next-gen technologies,
digital transformation, process improvements and consumer engagement. He can be reached at
Nikhil.Sarathi@cognizant.com | www.linkedin.com/in/nikhilsarathi/.
Shashi Shrimali
Director of Healthcare Consulting, and Front Office Transformation Service Line Leader,
Cognizant Consulting
Shashi Shrimali is a Health Plan Front Office Transformation Service Line Leader within Cognizant
Consulting’s Healthcare Practice. He has over 15 years of experience in management consulting, IT
strategy, digital transformation and operating model design across industries with a primary focus on
healthcare. Shashi focuses on helping health plans design overall constituent experience, define and
mobilize product/sales/marketing/service strategy and drive both internal and external adoption. In
addition, he has led core administration modernization programs across nationals, Blues and regional plans.
Shashi can be reached at Shashi.Shrimali@cognizant.com | www.linkedin.com/in/shashishrimali/.
Sridhar Kondaveeti
Assistant Vice President and Sr. Client Partner, Cognizant Healthcare
Sridhar Kondaveeti (Konda) is a seasoned market leader in Cognizant’s Healthcare Practice, leading
the overall relationships for some of Cognizant’s largest healthcare customers. With over a couple
of decades of experience in the U.S. healthcare industry, Konda has deep expertise serving both
commercial and government plans. He advised many of the healthcare market leaders on their strategic
and transformative initiatives to achieve greater levels of efficiency and adapt to industry challenges
by leveraging next-generation processes, platforms and digital technologies. Konda is a Fellow of the
Academy for Healthcare Management, is an Emerging Partner from Harvard Business Publishing and
holds a bachelor of technology degree from Nagarjuna University. He can be reached at
Konda@cognizant.com | www.linkedin.com/in/sridharkondaveeti.
© Copyright 2019, Cognizant. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means,electronic, mechanical,
photocopying, recording, or otherwise, without the express written permission from Cognizant. The information contained herein is subject to change without notice. All other trademarks
mentioned herein are the property of their respective owners.
Codex 5098
About Digital Business
We help clients build digital businesses and innovate products that create new value — by using sensing, insights, software and experience to deliver on
what customers demand in the digital age. Through IoT we connect the digital and physical worlds to make smart, efficient and safe products, operations
and enterprises. Leveraging data, analytics and AI we drive intelligent decisions and anticipate where markets and customers are going next. Then we
use those insights, combining design and software to deliver the experiences that consumers expect of their brands. Learn more about how we’re
engineering the modern enterprise at cognizant.com/digitalbusiness.
About Cognizant Healthcare
Cognizant’s Healthcare Business Unit works with healthcare organizations to provide collaborative, innovative solutions that address the industry’s most
pressing IT and business challenges — from rethinking new business models to optimizing operations and enabling technology innovation. A global
leader in healthcare, our industry-specific services and solutions support leading payers, providers and pharmacy benefit managers worldwide. For more
information, visit www.cognizant.com/healthcare.
About Cognizant
Cognizant (Nasdaq-100: CTSH) is one of the world’s leading professional services companies, transforming clients’ business, operating and
technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innovative and
efficient businesses. Headquartered in the U.S., Cognizant is ranked 193 on the Fortune 500 and is consistently listed among the most admired
companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com or follow us @Cognizant.
World Headquarters
500 Frank W. Burr Blvd.
Teaneck, NJ 07666 USA
Phone: +1 201 801 0233
Fax: +1 201 801 0243
Toll Free: +1 888 937 3277
European Headquarters
1 Kingdom Street
Paddington Central
London W2 6BD England
Phone: +44 (0) 20 7297 7600
Fax: +44 (0) 20 7121 0102
India Operations Headquarters
#5/535 Old Mahabalipuram Road
Okkiyam Pettai, Thoraipakkam
Chennai, 600 096 India
Phone: +91 (0) 44 4209 6000
Fax: +91 (0) 44 4209 6060
APAC Headquarters
1 Changi Business Park Crescent,
Plaza 8@CBP # 07-04/05/06,
Tower A, Singapore 486025
Phone: + 65 6812 4051
Fax: + 65 6324 4051

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AI at Your Service: Modernizing the Payer Contact Center

  • 1. Digital Business AI at Your Service: Modernizing the Payer Contact Center Here’s how AI will enhance the consumer experience across health plan contact center touchpoints. Executive Summary Digitally adept companies, such as Amazon and Uber, are elevating consumer demands for convenient, personalized and intelligent experiences. Artificial intelligence (AI) and its related technologies — analytics, intelligent process automation (IPA), machine learning (ML) and natural language processing (NLP) — are the engines driving these experiences. AI has become critically important for players in the healthcare sector, as it helps increase business value through contact center operations by converting data into meaningful insights that enhance consumer interactions. At a foundational level, AI streamlines processes, freeing contact center associates to focus on higher value consumer interactions. As AI matures, it will transform consumer experiences by delivering real-time insights that enable payers to anticipate and proactively resolve consumer issues. Whether through a software bot that makes simple yes/no rules-based decisions or an algorithm that sifts through data patterns to find at-risk members, AI first creates, then continuously layers, details and insights onto portraits of health plan members. As a member profile grows richer over time, AI tools draw on details Cognizant 20-20 Insights December 2019
  • 2. such as health status, claims history, shifting demographics and so on to recommend actions and forecast member-specific needs. Equipped with these insights, payers can respond quickly and appropriately to changing member needs, build brand loyalty and expand payer revenue channels. Today, AI tools enable payers to quickly and cost- effectively deploy new capabilities and create a foundation for modern member experiences. Payers that leverage AI in their contact centers can gain an early lead in differentiating their services and building sustainable, value generating, lifetime member relationships. In this white paper, we will help payers understand the benefits and opportunities as they embark on their AI journey by addressing: ❙❙ How is AI essential for attracting and retaining members? ❙❙ How can AI enable better and more actionable insights with higher precision? ❙❙ Where should payers start and how can they accelerate their AI transformation journeys? Cognizant 20-20 Insights 2  /  AI at Your Service: Modernizing the Payer Contact Center
  • 3. Cognizant 20-20 Insights 3  /  AI at Your Service: Modernizing the Payer Contact Center Cognizant 20-20 Insights AI: Essential to delivering modern member experiences Members rate their health plan service experiences as “okay” at best (see Figure 1). 1 Further, a third of plan members say they will switch health plans after a bad service experience. 2 With a member’s lifetime value estimated at $1.4 million, bad experiences can result in significant losses. 3 Based on our observations, many payers have increased their investments in digital tools and contact center technologies, but have yet to realize the desired improvements. It’s likely that these payers have not fully analyzed their member journeys and considered their expectations when designing tools or they have not invested sufficient resources in member digital-tool adoption campaigns. 4 Base: 10,000 U.S. Consumers Source: Temkin Group Q1 2018 Consumer Benchmark Survey Figure 1 Healthcare is lagging... 2018 Temkin Experience Ratings (TxR), Range of Industry Scores Very Poor Poor Okay Good Excellent Low Score Industry Average High Score 50% 60% 70% 80% Fast Food Chains Retailers Banks Parcel Delivery Streaming Media Hotels & Rooms Credit Cards Investment Firms Insurance Carriers TV & Appliances Wireless Carriers Auto Dealers Airlines Computers & Tablets Utilities Software Firms Rental Cars & Transport Supermarket Chains TV/Internet Services Health Plans
  • 4. Cognizant 20-20 Insights 4  /  AI at Your Service: Modernizing the Payer Contact Center Evolving consumer needs and preferences require payers to reimagine their relationship with members. It’s no longer “business as usual.” Understanding a member’s claim history, medications and other details alone is not enough. Payers must think further ahead into their member’s journey and identify areas where they can proactively help manage care needs and lead a healthy lifestyle (see Figure 2). AI tools are essential to meet these new and ever- expanding member expectations. Only AI can help keep pace with and make sense of the petabytes of data generated through member interactions, wearable devices and other inputs. As AI tools create insights, payers can use these insights to improve consumer experiences and transform the contact center into a profit center. Let’s look at a few other industries that are embracing the power of AI in their contact centers to generate profitable growth: ❙❙ The online retailer Asos used a chatbot to interact with customers and make appointments for fashion makeovers. As a result, appointments rose 11%, order volume via chat increased by 300% and return on spend grew 250% while the company reached 3.5 times more prospective customers. 5 Today’s health plan members demand more personalized, “warm” experiences that reflect their unique needs and situations. Delivering these experiences requires payers to rethink the contact center, equipping it to become an opportunity center that drives member loyalty and enhances their lifetime value. Figure 2 Consumers demand service their way On time availability Good communication skills Resolving problems, providing advice, administering sales Cost center Operational, cost Reactive, scripted, controlling 24x7 support across omnichannel social media integration Warm care, empathy, self service and readiness to listen Driving positive experience and lifetime loyalty Opportunity center Customer, experience Proactive, collaborative, unique Expectations change from... to...
  • 5. 5  /  AI at Your Service: Modernizing the Payer Contact Center Cognizant 20-20 Insights Within healthcare’s compliance boundaries, AI use in contact centers offers extensive opportunities. Vitally, payers must understand that their AI end game should aim to create comprehensive, insight-filled member portraits. ❙❙ Amazon uses deep learning to personalize recommendations at nearly every step of its customers’ journeys on category, product and checkout pages. About 70% of Amazon’s screen real estate supports recommendations, which drive a third of its revenue. 6 ❙❙ At CenturyLink, an AI-driven assistant handles about 30,000 customer emails monthly and analyzes responses to identify important leads to route to appropriate departments. With 99% of emails correctly processed, company sale representatives have more time to focus on and follow up with high-value cases. 7 Across healthcare, more companies are adopting AI, especially in areas that improve the overall consumer experience: ❙❙ Pager, a digitally native company, uses ML to analyze clinical and claims data to discover gaps in a patient’s treatment, make recommendations and help patients schedule appointments. 8 ❙❙ zakipoint Health automates the task of displaying relevant healthcare data to members via a dashboard that improves engagement and healthy behavior adoption to better support cost containment. 9 ❙❙ Several large payers such as Aetna analyze the emotional sentiment of call center conversations using NLP. Sentiment analysis helps them understand the caller’s intent to help improve the customer experience and agent training. 10 ❙❙ Anthem is partnering with health research firm doc.ai to explore how AI can be used to predict when people will experience allergies or allergy patterns. 11 ❙❙ Aetna, in collaboration with Apple, launched a new health app to provide users with personalized health goals. Aetna’s new Attain app allows Apple Watch users to track daily activity levels, receive recommended healthy actions, improve nutrition and aid sleep habits. 12 Within healthcare’s compliance boundaries, AI use in contact centers offers extensive opportunities. Vitally, payers must understand that their AI end game should aim to create comprehensive, insight-filled member portraits. Without this objective, payers may deploy AI apps that do not necessarily contribute to a long-term ROI strategy. Understanding the current limits and future capabilities of AI and how to best leverage it will help payers quickly deploy AI with purpose and direction to enhance the member experience and develop sustainable new revenue streams.
  • 6. Cognizant 20-20 Insights 6  /  AI at Your Service: Modernizing the Payer Contact Center The AI maturity continuum: Building a hyper- personalized ‘member portrait’ AI technologies transcend a range of capabilities across the maturity continuum, from software bots that make simple decisions to highly sophisticated algorithms that proactively identify and address emerging issues (see Figure 3). Member data is captured at every point along this continuum, which feeds a comprehensive member portrait. Member- specific data may include details related to claims and health history, clinical insights, provider notes, communications channel preferences, financial details, sentiments during different interactions, medication adherence, and responses to different plan and wellness offerings. This data should be assigned to appropriate member portrait categories. AI technologies leverage these data points to augment and support human agents during interactions with members and, in many cases, can initiate member engagements proactively based on the data-driven insights. Most organizations start their AI journey by automating rote processes and creating rules engines that streamline and optimize contact center workflows and processes. These efforts may include deploying virtual assistants that can execute simple tasks such as pulling up benefits for website visitors; rules to automate call routing; and interactive voice response (IVR) systems that leverage NLP. As AI technology matures, cognitive AI tools at all maturity levels can enable payers to build in-depth member portraits. AI-based systems continually draw on and add layers to these portraits to help contact-center agents deliver personalized services. Figure 3 The AI capabilities maturity continuum Guide with next best actions. Cognitive search to provide help to resolve member and provider issues and queries. Proactive & personalized lifestyle and wellness insights. Augment self- service tools with improved provider, benefit, claims and member data. Customer speech & sentiment analysis. Claims adjustment insights; intelligent appeals and grievances management. Interaction tracking and experience management. Establish member & provider 360-degree view across all interaction points. Complaints classification & routing to avoid regulatory fines. Personalized reminders for healthcare actions. Augmented sales support with personalized offers. Process improvement, and new workflows within existing systems. Deploying new data, analytics and technology capabilities. Applying ongoing insight with the context and user preference in mind (e.g., time, location). Creating an intuitive, consistent omnichannel & seamless service experience. Embedding new tools that help to navigate the healthcare ecosystem. Utilizing member data to proactively provide personal- ized services. Optimization Modernization Self-service Navigation Advocacy Empowerment
  • 7. Cognizant 20-20 Insights 7  /  AI at Your Service: Modernizing the Payer Contact Center search tools will help members resolve queries themselves. Payers should focus on programs that enable greater customer self-service. For such, it’s essential to capture and understand every detail in the member’s portrait and use the right tools and channels based on unique member situations. As an example, a member who inquires about a provider address or benefit detail for an annual checkup can be directed to self-service tools, but a member requiring details for a close family member’s critical care related to a recent surgery should gain immediate access to a contact center agent to receive warm, empathetic care. AI should continuously analyze new data as it’s added to the member portrait. Further, AI augmented with ML algorithms can learn member preferences, at both individual and aggregate levels. This capacity enables the system to predict member needs, such as applying self-service options for a simple inquiry or providing detailed advice about plan options, health choices and general wellness. AI tools also can predict member adherence and acceptance to outreach and care management programs and, thereby, recommend optimal engagement tactics and channels, and identify members who might require proactive interventions. Additionally, AI-based sentiment analysis can predict a member’s temperament and prepare an appropriate response, such as immediately connecting a member who has a chronic condition to a live agent. AI can also recognize when a member’s lifestyle or circumstances change and recommend plans and services that meet emerging needs. Here’s one common scenario that demonstrates how AI-based tools support member needs: A plan member’s son is turning 26 and soon will no longer be covered under his parent’s policy. At the least mature end of the AI spectrum, a software bot could automatically send an email to the parents to note the coming change in their premium. A more advanced bot might push promotional material to the son via his preferred channel. At the highest maturity level, an AI-based solution would identify the son as a potential prospect before he ages out and ensure there is a focused marketing effort to have him continue with the health plan after age-out. Mature AI capabilities can ensure the target member receives the right type of plan recommendations that leverage the right interaction channel based on their unique member portrait developed over time. AI should continuously analyze new data as it’s added to the member portrait. Further, AI augmented with ML algorithms can learn member preferences, at both individual and aggregate levels.
  • 8. Cognizant 20-20 Insights 8  /  AI at Your Service: Modernizing the Payer Contact Center Payers can deliver compelling member experiences while achieving significant cost savings by augmenting customer service representatives and business processes with more mature AI capabilities. Figure 4 Service experience can be transformed with AI Optimizes existing manual and fragmented processes. Frees the workforce from simple repetitive tasks — but human intervention is required. Robotic Desktop Automation (RDA) Process: standard/rule-based. Information: structured. Automates rule-based processes. Also, makes cleansed data from various sources accessible to AI platform. Unassisted automation. Robotic Process Automation (RPA) Process: standard/nonstandard. Information: structured/unstructured. Makes human-like judgmental decisions, based on training and historical data using AI. ML technology to handle complex exceptions. AI-Powered Business Processes Level1 Level2 Level3 Robotic Desktop Automation Robotic Process Automation AI Powered Automation Cost savings ~up to 5% Cost savings +25% Cost savings +50% + Organizations are moving from level 2 to level 3 to increase operational efficiency and reduce costs. AI use cases for payers Most payers have vast stores of member data. By applying AI tools to these resources and creating member portraits, payers can glean insights that help them operate more efficiently and improve member experiences (see Figure 4). To begin, payers may use existing member data to create a baseline member portrait and continuously add additional insights from incoming streams of data for the same member. Gradually, a robust member portrait will emerge. Continual additions of data help enhance the portrait with increased precision and personalization. Deep insights about individual members can be derived by analyzing member portraits. By identifying common patterns across individual member portraits, payers can isolate critical high-priority issues for quick wins. Here are a few examples of potential AI-enabled service enhancements around the member portrait: ❙❙ Member self-service options: Develop and show personalized content based on history and context. Improve and customize search functionality – e.g., focus on content aligned with the member’s context and portrait. ❙❙ Agent augmentation: Enhance the experience by using AI to provide the agent with a complete member portrait along with their contextual information. For example, AI can help agents proactively call the member or predict the reason for a call based on the time of year, call location, past medication needs, family medication history, recent claims or individual preferences.
  • 9. Cognizant 20-20 Insights 9  /  AI at Your Service: Modernizing the Payer Contact Center ❙❙ Member advocate: AI supports member needs and helps proactively identify problem areas, challenges and opportunities, and ensures the payer responds in a manner that delights the member. For example, using the member’s history, the system can identify additional tests needed as part of their annual check-up, schedule additional specialist appointments, and auto-generate and approve pre-authorizations for tests if needed. Payers may also develop innovative new member services built on the AI-driven contact center capabilities. Health plan members told us they are willing to share digital data from their wearables and home monitoring devices with payers in return for customized advice and incentives. 13 AI could use that data to glean more insights about community and population health issues as well as develop personalized analyses for members. Payers should be mindful that as AI matures and becomes more proactive, they will need to ensure their AI-based tools are responsible and ethical (see Quick Take, page 11). Getting started For our clients, we advise a “10-10-10” approach to guide the adoption of AI capabilities in contact centers: 10 Days ❙❙ Define what AI means to the organization with respect to contact center enhancements. >> AI is not a technology play. While AI technology is an enabler, its implementation must be business driven. Successful implementation in the contact center requires process redesign championed by business leaders. >> Get leadership buy-in and support of the AI value propositions, which should include projected cost reductions through operational and experience improvements. ❙❙ Identify and plan a minimum viable product or proof of concept. >> Identify and assess AI opportunities across applications, infrastructure and security operations to define the target state. Specific AI examples include AI-powered IVR, automated routing and automated agent guidance. Promote overall contact center efficiency and effectiveness by having agents focus on delivering warm, empathetic care that results in a truly differentiated member experience. >> Analyze functional and technical requirements to attain a best-fit approach for the AI-powered layer. >> Assess AI algorithms to ensure automation and learnings align with business goals.
  • 10. Cognizant 20-20 Insights 10  /  AI at Your Service: Modernizing the Payer Contact Center 10 Weeks ❙❙ Implement a minimum viable product. >> Establish an agile team comprising business and technical resources. >> Design and develop the minimum viable product. >> Garner feedback from the user community and optimize the AI algorithm. >> Fine-tune the overall implementation approach and roadmap based on the lessons learned. >> Leverage the lessons learned to inform the overall AI strategy. ❙❙ Define an enterprise-wide contact center AI strategy. >> Consider adopting an AI-first mindset, which requires using AI to solve business problems wherever applicable and possible. >> Move from piecemeal AI-oriented efforts to a mainstream, dedicated and executive- sponsored effort to drive AI. >> Define a strategy that will address business challenges. Identify capabilities needed to develop in-depth member portraits that can improve the member experience. ❙❙ Define a high-level two to three year roadmap for contact-center-focused AI capabilities. >> Quantify automation and AI benefits, develop a roadmap and calculate high-level ROI. Socialize with and obtain buy-in from business stakeholders. 10 Months ❙❙ Develop a comprehensive operating model to operationalize AI. >> Analyze the impact of AI capabilities across people, processes and technologies. >> Establish an AI center of excellence to drive AI best practices across the organization and establish governance standards, noting that most large organizations must accommodate some level of customization. >> Conduct skills assessment within the current workforce and retrain, hire or source the right skills. >> Design the right incentives to drive AI adoption across the organization. ❙❙ Continue to implement the AI capabilities that have the most member and business impact, and continuously incorporate the learnings from new use-case implementations into the overall strategy.
  • 11. Cognizant 20-20 Insights 11  /  AI at Your Service: Modernizing the Payer Contact Center Ensuring Strong Ethics for Effective Contact Center AI According to our recent multi-industry AI study, only about half of the respondents said their companies have policies and procedures in place to identify and address ethical considerations in their AI applications. 14 Healthcare executives must be part of this group of early ethics adopters because so many AI-based decisions will affect what and how care is delivered. Ethical policies, procedures and governance programs are critical to successful AI applications, and should be a chief concern across the healthcare industry. Members, patients and payer employees should be served through AI that is responsible and ethical. For example, an AI agent that suggests a new service for a member who just received bad health news should be sensitive to the member’s status. Although the AI might present the offer as a logical response to a change in health status, the member might find the communication or offer manipulative or intrusive. Payers need to think through these scenarios as part of a broad AI ethics and responsibility strategy that incorporates the following: ❙❙ Governance: AI’s effective use requires ongoing input, support and review throughout the payer organization. With governance mechanisms in place, payers should be prepared to cease or reconfigure an AI initiative that’s showing unwanted results. >> A chief AI ethicist: As part of a strong governance program, this role would be responsible for the actions and outcomes of decisions made with or augmented by AI. ❙❙ Control for bias in AI: Businesses must understand the typical types of bias that can creep into AI system design and ongoing operations without proper controls. 15 First, there’s bias that stems from the data used to train the system. If the data is biased or used out of context, the resulting outcomes also will be biased. Organizations must also account for unconscious bias by employees who create the AI systems. Humans tend to reflect their own experiences and beliefs, so teams lacking diverse perspectives may create a biased program. Finally, bias can be propagated by self-learning AI systems that Quick Take
  • 12. Cognizant 20-20 Insights 12  /  AI at Your Service: Modernizing the Payer Contact Center work with biased data or come to conclusions based on biased data or processes. It is very important to have a rigorous quality assurance program that addresses these biases and removes them through iterations. ❙❙ Transparency: As AI-based solutions learn, it often becomes increasingly unclear how the algorithms within them are evolving, so that they are likened to a “black box.” Members and providers are unlikely to accept AI-based decisions if payers can’t explain how the AI agent arrived at them. Payers should work closely with their service providers to ensure visibility into how its algorithms work. 16 It is also important to model these algorithms with high volumes of data in test environments, and continuously monitor the results and modify the algorithms as needed over time. ❙❙ A plan for unintended consequences: When designing AI systems, organizations must recognize that people likely will behave differently if they know they’re interacting with an AI system. For example, a member unlikely to berate a human customer service agent might otherwise scream at a chatbot. A few might do so to game the system. 17 Another reason why payers and their service providers must build AI applications on a strong ethical foundation: As AI systems proliferate, they will be taught by other AI systems. If unchecked, an unethical AI system will propagate its biases and other issues, negating any positive impact. Ultimately, humans are responsible for controlling the behavior of their AI systems and ensuring they achieve desired and ethical outcomes that are consistent with the payer’s values and member priorities. Quick Take
  • 13. Cognizant 20-20 Insights 13  /  AI at Your Service: Modernizing the Payer Contact Center Endnotes 1 Temkin, Bruce, 2018 Temkin Experience Ratings, Qualtrics XM Institute, March 2018, www.qualtrics.com/docs/xmi/XMI_TemkinExperienceRatings-2018.pdf 2 Shea, William; Shrimali, Shashi; Kama, Carolyne, “Extending the Case for Digital: Health Plan Members Speak,” 2018, Cognizant, www.cognizant.com/whitepapers/extending-the-case-for-digital-health-plan-members-speak-codex3814.pdf 3 Wynne, Brian, “The real reason loyalty lacks in healthcare,” May 2, 2018, Becker’s Hospital Review, www. beckershospitalreview.com/population-health/the-real-reason-loyalty-lacks-in-healthcare.html 4 Shea, William, “Why haven’t health plan members adopted digital tools? Hint: it’s probably the tools, DigitallyCognizant, https://digitally.cognizant.com/why-havent-health-plan-members-adopted-digital-tools-hint-its-probably-the-tools- codex3953/ 5 Kojouharov, Stefan, “How Businesses are Winning with Chatbots & AI,” Jan. 24, 2018, https://chatbotslife.com/how-businesses-are-winning-with-chatbots-ai-5df2f6304f81 6 Schneider, Gene, “Learning from Amazon’s embrace of personalization, by Gene Schneider | March 6, 2018, SPS Commerce Inc. www.spscommerce.com/blog/amazon-embraces-personalization-spsa/ 7 Power, Brad, “How AI Is Streamlining Marketing and Sales,” June 12, 2017, Harvard Business Review, https://hbr.org/2017/06/how-ai-is-streamlining-marketing-and-sales 8 https://pager.com 9 https://zakipointhealth.com/z5-platform-2/ 10 “This Call May be Monitored to Help Us Help You,” HBS Digital Initiative, April 9, 2018, https://digital.hbs.edu/platform-digit/submission/this-call-may-be-monitored-to-help-us-help-you/ 11 Townsend, Tess, “Anthem thinks its ‘virtuous cycle’ with doc.ai can improve patient care,” Venture Beat, July 11, 2019, https://venturebeat.com/2019/07/11/anthem-thinks-its-virtuous-cycle-with-doc-ai-can-improve-patient-care/ 12 Thakar, Subrata, “Aetna, Apple launch AI-based app to achieve personal health goals,” HealthExec, Jan. 29, 2019, www.healthexec.com/topics/health-it/aetna-apple-launch-ai-based-app 13 Shea, William; Shrimali, Shashi; Kama, Carolyne, “Extending the Case for Digital: Health Plan Members Speak,” 2018, Cognizant, www.cognizant.com/whitepapers/extending-the-case-for-digital-health-plan-members-speak-codex3814.pdf 14 Ramaswamy, Poornima, Jeude, James, Smith, Jerry A., “Making AI Responsible—and Effective,” www.cognizant.com/whitepapers/making-ai-responsible-and-effective-codex3974.pdf 15 Ramaswamy, Poornima, “The Road to AI,” www.cognizant.com/whitepapers/the-road-to-ai-codex3614.pdf 16 Cohen, Jessica Kim, “Liability concerns may pose roadblock for hospital AI, “ Modern Healthcare www.modernhealthcare.com/technology/liability-concerns-may-pose-roadblock-hospital-ai 17 Smith, Jerry; Ramaswamy, Poornima; Jeude, James, “Eight Ways to Forge a Path to Real and Responsible AI,” https://digitally.cognizant.com/eight-ways-to-realize-real-and-responsible-ai-codex4304/ Acknowledgments The authors would like to thank the following Cognizant personnel for their invaluable contributions to this paper: ❙❙ Sudhir Dutt, Manager of Consulting ❙❙ Illamathy Erode Nallasamy, Senior Consultant ❙❙ Aman Preet , Senior Consultant ❙❙ Harsh Kulkarni, Business Analyst ❙❙ Vikram Shankar, Business Analyst ❙❙ Shwetana Sunkari, Consultant ❙❙ Ishita Malhi, Business Analyst
  • 14. Cognizant 20-20 Insights 14  /  AI at Your Service: Modernizing the Payer Contact Center About the authors Nikhil Sarathi Consulting Partner and Global Lead for Consumerism, Cognizant Consulting Nikhil Sarathi is an Assistant Vice President within Cognizant Consulting’s Healthcare Practice. He has over 18 years of experience in healthcare and technology, and has a strong track record of success in consumer-centric strategies, next-generation capabilities identification and implementation, leading large digital transformation programs and evaluating partnership models for healthcare organizations. Nikhil specializes in the areas of strategy development and execution, platform strategies, next-gen technologies, digital transformation, process improvements and consumer engagement. He can be reached at Nikhil.Sarathi@cognizant.com | www.linkedin.com/in/nikhilsarathi/. Shashi Shrimali Director of Healthcare Consulting, and Front Office Transformation Service Line Leader, Cognizant Consulting Shashi Shrimali is a Health Plan Front Office Transformation Service Line Leader within Cognizant Consulting’s Healthcare Practice. He has over 15 years of experience in management consulting, IT strategy, digital transformation and operating model design across industries with a primary focus on healthcare. Shashi focuses on helping health plans design overall constituent experience, define and mobilize product/sales/marketing/service strategy and drive both internal and external adoption. In addition, he has led core administration modernization programs across nationals, Blues and regional plans. Shashi can be reached at Shashi.Shrimali@cognizant.com | www.linkedin.com/in/shashishrimali/. Sridhar Kondaveeti Assistant Vice President and Sr. Client Partner, Cognizant Healthcare Sridhar Kondaveeti (Konda) is a seasoned market leader in Cognizant’s Healthcare Practice, leading the overall relationships for some of Cognizant’s largest healthcare customers. With over a couple of decades of experience in the U.S. healthcare industry, Konda has deep expertise serving both commercial and government plans. He advised many of the healthcare market leaders on their strategic and transformative initiatives to achieve greater levels of efficiency and adapt to industry challenges by leveraging next-generation processes, platforms and digital technologies. Konda is a Fellow of the Academy for Healthcare Management, is an Emerging Partner from Harvard Business Publishing and holds a bachelor of technology degree from Nagarjuna University. He can be reached at Konda@cognizant.com | www.linkedin.com/in/sridharkondaveeti.
  • 15. © Copyright 2019, Cognizant. All rights reserved. No part of this document may be reproduced, stored in a retrieval system, transmitted in any form or by any means,electronic, mechanical, photocopying, recording, or otherwise, without the express written permission from Cognizant. The information contained herein is subject to change without notice. All other trademarks mentioned herein are the property of their respective owners. Codex 5098 About Digital Business We help clients build digital businesses and innovate products that create new value — by using sensing, insights, software and experience to deliver on what customers demand in the digital age. Through IoT we connect the digital and physical worlds to make smart, efficient and safe products, operations and enterprises. Leveraging data, analytics and AI we drive intelligent decisions and anticipate where markets and customers are going next. Then we use those insights, combining design and software to deliver the experiences that consumers expect of their brands. Learn more about how we’re engineering the modern enterprise at cognizant.com/digitalbusiness. About Cognizant Healthcare Cognizant’s Healthcare Business Unit works with healthcare organizations to provide collaborative, innovative solutions that address the industry’s most pressing IT and business challenges — from rethinking new business models to optimizing operations and enabling technology innovation. A global leader in healthcare, our industry-specific services and solutions support leading payers, providers and pharmacy benefit managers worldwide. For more information, visit www.cognizant.com/healthcare. About Cognizant Cognizant (Nasdaq-100: CTSH) is one of the world’s leading professional services companies, transforming clients’ business, operating and technology models for the digital era. Our unique industry-based, consultative approach helps clients envision, build and run more innovative and efficient businesses. Headquartered in the U.S., Cognizant is ranked 193 on the Fortune 500 and is consistently listed among the most admired companies in the world. Learn how Cognizant helps clients lead with digital at www.cognizant.com or follow us @Cognizant. World Headquarters 500 Frank W. Burr Blvd. Teaneck, NJ 07666 USA Phone: +1 201 801 0233 Fax: +1 201 801 0243 Toll Free: +1 888 937 3277 European Headquarters 1 Kingdom Street Paddington Central London W2 6BD England Phone: +44 (0) 20 7297 7600 Fax: +44 (0) 20 7121 0102 India Operations Headquarters #5/535 Old Mahabalipuram Road Okkiyam Pettai, Thoraipakkam Chennai, 600 096 India Phone: +91 (0) 44 4209 6000 Fax: +91 (0) 44 4209 6060 APAC Headquarters 1 Changi Business Park Crescent, Plaza 8@CBP # 07-04/05/06, Tower A, Singapore 486025 Phone: + 65 6812 4051 Fax: + 65 6324 4051