AI chatbots in healthcare are on the rise as companies roll out artificial intelligence assistants and consumers turn to tools like ChatGPT to diagnose health-related issues.
But many general-purpose chatbots come up short when it comes to offering personalized health guidance tailored to a particular individual.
Included Health, a virtual care and health navigation company, spent the past 18 months developing what it calls a personalized AI assistant and chatbot, called Dot, to offer members an "always-on, clinician-in-the-loop experience" assisted by AI. Dot can answer members' questions about their specific health benefits and coverage and help find in-network providers. And the chatbot works hand-in-hand with Included Health's employed clinicians and care advocates.
Included Health works with health plans and employers, including over one-third of the Fortune 10, and provides healthcare benefits and insurance navigation, along with virtual primary care, behavioral health, specialty care, expert medical opinions, and all-hours urgent care appointments.
The company was built out of the merger of Grand Rounds Health and Doctor on Demand in 2021. The combination brought together Grand Rounds' capabilities to virtually connect patients with top-ranked medical experts for a second opinion, with Doctor On Demand's service to provide on-demand and scheduled visits with healthcare providers in both medical and behavioral health.
Dot draws on claims data, benefits and coverage information, systemwide utilization and cost patterns, proprietary physician-quality models and insights tied to social determinants of health, according to Included Health executives. The company uses an enterprise-grade electronic health record for its clinical team and can also access members' medical history to provide personalized health guidance.
"We have trained Dot on clients' specific data, on everything about that client's benefits -- what's covered, what's not covered, what's in the plan document, what benefits they have access to. So a member can ask Dot, 'Is this covered or not covered? How much of my deductible is left? Help me pick a high-quality provider.' We know exactly who's in network because we have access to that particular company's data," Nupur Srivastava, chief operating officer at Included Health, told Fierce Healthcare.
The aim is to use Dot to extend Included Health's capabilities to provide "mind, body and wallet support" to members, according to the company.
Over the past year, Dot has been refined and scaled with some of the nation’s largest employers, processing more than ten billion AI tokens to date, executives said.
The AI assistant has handled thousands of chats and is used by approximately 300 employers and health plans, Srivastava said.
Included Health is exploring the potential to expand its AI assistant directly to consumers, beyond its work with employers and health plans, she noted.
"There's many directions we could take this. In an urgent care practice, we're using Dot to customize intake. You could imagine a world where a bot like this could sit in a direct-to-consumer practice that's helping with doing some light triage and then escalating it to a clinical service. I do think many other entities could benefit from leveraging Dot. Our tech teams are really excited to explore the boundaries of that, given how useful Dot has been," she said.
Dot also offers what Srivastava calls "light clinical guidance." For example, if a member is chatting with Dot and mentions having sleep problems due to stress, Dot may suggest relaxation techniques and remind the member of the benefits of a healthy lifestyle, like drinking plenty of water and getting outside for fresh air.
When a situation requires more support, human clinicians are always in the loop, Srivastava said. The AI assistant continues Included Health's work to combine AI with emotional intelligence (EQ), she noted, as it offers members faster answers from AI combined with seamless support from human clinicians.
"We can quickly escalate to a human, so a clinician can be on the phone with you. We have a 24/7 triage line. We can transfer the context of what member that clinician has talked about with Dot to that clinician who can actually diagnose or treat you," she said.
Through Dot, members can be connected to longitudinal virtual care, or the AI assistant can initiate referrals to local providers and expert medical opinions from leading academic medical centers nationwide, according to the company.
"Members in general are happy with Dot because the moment Dot doesn't know an answer, we can escalate to a human. All members care about is, you just have to resolve my need, whether it's a chatbot or a human, they don't really care. They just want you to do it in a fast way and in a way that's accurate, so accuracy for us is incredibly important," she said.
Included Health developed Dot with rigorous oversight by in-house medical experts to ensure safety and accuracy. The company's in-house clinical teams established strict clinical guardrails, Srivastava said.
With general-purpose chatbots, if a user mentions a serious mental health or physical health issue, no action is taken.
With Included Health's AI assistant, if a member were to mention the idea of suicidal ideation during a conversation with Dot, the situation would be escalated to a member of Included Health's clinical team who would quickly call the member, Srivastava said.
"We are a medical practice. We have a much higher bar for what we consider clinically appropriate for a chatbot to chat about and we lean into that," she said. "You're never stuck in this endless loop with the chatbot that can't answer your question. We want to be helpful to members, but we also want to be safe, and we don't want to take the conversation very far."
Included Health developed Dot by building on more than a decade of work in machine learning and virtual-first care delivery.
"We've been working with AI since the start of the company. As a healthcare company, we always have to have the highest safety standards on the way we handle our data, so security is a big part of investment for us," Srivastava said.
“Dot is core to our personalized all-in-one healthcare model, which has always been about combining the best in technology with the best in clinical and system expertise, and human empathy to make healthcare simpler for people,” said Ami Parekh, MD, chief health officer at Included Health.
Included Health members are comfortable with the company making customized recommendations based on their health data, and Dot is an extension of that capability, she noted. Individuals now expect more personalization rather than a one-size-fits-all experience, given their interactions with other apps in their day-to-day lives.
"We'll keep a close eye on the impact that Dot is driving, but I've been pretty impressed so far. We're also measuring how it is improving the experience of our care and clinical team. The early results are actually pretty promising. I'm pretty bullish on where this could go," Srivastava said.
Future plans for AI-enabled healthcare
Included Health has broader ambitions for Dot than to just answer questions about coverage and benefits.
The company plans to use the AI assistant to nudge people toward preventive screenings and better benefits utilization, engage at-risk individuals and support adherence to care plans.
Dot will also reach out to members to check in on their mental and physical health as part of Included Health’s Healthy Days program. "Dot can be a friendly extension of the care clinical team that's checking in on you and offering a low-friction way to have a conversation with us," Srivastava said.
Beyond clinical guidance, Dot will also fully handle tasks like scheduling appointments with in-person or virtual providers.
"We're trying to use Dot to drive up clinical engagement in a big way and lead members to more clinical services where appropriate," she said.
These efforts align with employers' and health plans' focus on driving better outcomes and lower costs.
Srivastava sees the potential to leverage AI to support population health efforts as well.
"I think other opportunities exist that we're exploring around using AI for potentially better insight generation. Our clients want to understand trends from a population health perspective," she said.
The company has been building what it describes as a personalized engagement engine based on members' health profiles, married with other data insights.
"Using those insights could trigger an event where Dot reaches out to check in on whether you've gotten your flu shot. We do some of this today, but AI can supercharge this. We can look at who is at the age of 40 and has done their appropriate cancer screenings and reach out to help a member take action on that. The beauty with Included Health is we don't just tell you, we can actually help you do it," Srivastava said.
Included Health's efforts to be a first-mover on AI also could be a point of differentiation in a crowded market that targets employers.
"We're seeing some of our buyers have corporate mandate to use AI in their products. Some benefits leaders are being asked by their leaders about how are you using AI in your benefits? Some of them are also looking for innovative companies like us that are leaning into AI in a big way, so that we can show innovation and forward-thinking in how we can use AI in a safe and responsible way that's member-centric to significantly improve the health of the population," Srivastava said.