The pace of digital innovation in healthcare is rapidly accelerating, and, for the team at Elevance Health, a simple mantra remains at the heart of its efforts: Keep the member at the center.
Ratnakar Lavu, executive vice president and chief digital information officer at Elevance, told Fierce Healthcare in an interview that the perspective is born from his experience in consumer industries like retail, where many patients form their expectations for digital experiences.
Digital platforms can make things simpler and more personalized for members, he said, but there’s also a risk of deploying new tech just for the sake of it.
“My obsession always has been, let's focus on the consumer, the member, and in our case, the patient, and keep them at the center of how we think about overall transformation,” he said. “Because it's not technology for the sake of technology, it is really trying to focus on the experiences that we want to bring to life.”
Artificial intelligence is a critical component in the equation for innovating in the digital space.
Examples of this at work include new programs available in the insurer’s call centers, which make it easier for workers to triage member needs. AI is used to generate call summaries, which frees up employees from manual tasks and allows for more efficient service.
The company’s consumer-facing app, Sydney, uses AI for live translation from English to Spanish, with plans to expand to additional languages in the future. The real-time translations have led to shorter wait times and improved satisfaction among patients.
The team is also leaning on AI for personalized and direct patient outreach, including alerts sent via text, the app or email that aim to close care gaps as well as tools that can help patients find the right provider to meet their needs.
Lavu said it’s critical to identify the most valuable touchpoints when considering where to deploy AI and other tech and to acknowledge, for some patients, that may not be within the plan’s digital ecosystem.
For example, there are some patients who would benefit from AI-surfaced insights at the point of care in the provider’s office, while others still prefer outreach via phone or other more traditional methods.
As an insurer like Elevance has a longitudinal view of the patient’s medical history, it’s positioned to assist even in those touchpoints that are outside of its app, portal or other consumer-facing platforms, he said.
“We understand who they are, we understand their benefit, we understand what they're looking for, and then we help guide them,” Lavu said. “But the key, I think, is we're building the right foundations to be able to do that [at] multiple touchpoints.”
In addition to finding ways for AI to improve the member experience, Elevance Health is also looking to use the technology to ease workflows for its team internally.
For instance, Lavu said the company is in the process of rolling out ChatGPT across the enterprise, which can allow the team to more effectively dig through documents and collate information.
Deploying AI also requires having the guardrails in place to ensure the technology is being used safely and ethically. AI carries a risk of data bias and can be prone to hallucinations.
Elevance Health has built a Responsible AI program that undergirds all of its work with the technology. The program has several key principles that guide it, among them accountability, transparency and privacy and security.
Lavu said it’s also important to start with ensuring the use case can be readily explained, making it easier to be transparent and accountable.
“We have a clear documentation as we are designing things, we have the element of starting with transparency and explainability and then we have our platform itself,” Lavu said. “And we do embed everything; we embed the responsibility into our software development life cycle.”
That said, while the potential of AI in healthcare is evolving quickly, there are still areas where it needs to be proven, he said. For patients with more complex care needs, for example, the jury is still out on how much of a role AI can play.
“We definitely know in those complex use cases, we need a lot more clinician oversight … and it has been predominantly that today,” Lavu said. “But then, how much can AI assist those clinicians to get to the right outcomes? That's one that is going to be the test, actually, for AI in healthcare, I think.”