AI innovative solutions to help improve the member experience

When it comes to using your health care benefits, the experience, ideally, should be like anything else you shop for or services you schedule. Much of the time, today’s consumers are making decisions based on information from a device they hold in their hand — and often, expect the options to be personalized, simpler and data-driven.

At UnitedHealthcare, we’re working with our partners at Optum to enhance experiences when consumers need to know about their benefits and coverage with the use of artificial intelligence (AI) to help take some of the complexity out of health care.  

Here are five ways.

Finding a doctor shouldn’t be one size fits all. The new Smart Choice capability, now available on the UHC app,¹ is designed to help you with more personalized provider information. This, in turn, helps provide easier access to care and more informed decision-making to help build confidence in your selection of primary care and specialist providers.

Leveraging Optum’s AI capabilities, Smart Choice displays results that reflect personalized search preferences you set for criteria like:

• Distance
• Language spoken
• Virtual or in-person appointments
• Gender preference
• Availability for evening and weekend appointments

Four key standards are used to help match members with a provider:²

• Quality: Factors that may impact quality of care like provider credentialing qualifications and whether physicians meet UnitedHealth Premium effective and efficient quality care criteria
• Benefits: Your health plan benefits and how you get the most from your plan
• Convenience: Where providers have appointments available (virtual or in-person) and their proximity to your location
• Personal fit: How a provider matches your personal preferences  
  
  

When you or your loved ones need help understanding the cost of care, you may ask a relative or friend if they’ve gone through a similar experience. With the ‘Members Like You’ cost estimates feature in the UnitedHealthcare (UHC) app, members can see general and anonymous demographic information, like gender and age, to get suggestions of the types of services commonly used by other members on a similar care journey.

Then, those member-specific insights come with cost estimates that can help provide clarity from the start by helping members feel confident in understanding their potential out-of-pocket costs. This can help eliminate surprises and help you stay informed through your care journey.

UnitedHealthcare's intelligent conversational voice assistant is powered by AI. It can converse in natural language to understand the reason for your call and make a determination of how best to support you by routing you to certain places related to provider, enrollment or benefit information whether via self-service or by transferring you to a live advocate. The AI does not give verbal answers to member questions.

By focusing on a clear, up-front understanding of the reason for your call, this tool can help to identify more opportunities for self-service through automation and get you where you need to be the first time. Designed to be faster, friendly and more reliable, UHC’s Conversational AI Voice can help support parts of health care journey — one conversation at a time.

The Claims Assistant AI tool supports out-of-network claim submissions for members by simplifying the process and helping to populate the medical field values, aimed at making reimbursement submission easier than before.

Claims assistant helps cut the time to completion of submitting out-of-network claims from 12-15 minutes down to 3 minutes. The completion rates have nearly doubled, as an outcome.³

When a member reaches out with a health care question, they’re connected to an experienced, compassionate advocate to help them and we’ve added AI tools to support those experiences so the advocate can focus more on you, the member. Questions related to health benefit navigation, coverage information or costs for services are what the AI helps answer for the advocate. Examples include:   

• Welcome experience: Provides key member insights based on claims activity or previous calls to the advocate before the call to streamline authentication and personalize support
• In-call assist: Uses voice analytics to understand the member’s needs and provides benefits, coverage and cost answers from the member's benefit plan
• In-call summarization: Summarizes the conversation so that advocates can add the summary to the member’s file so that when they call back the advocate doesn’t have to spend a long time understanding the member’s call history

These AI programs help create simpler interactions with your health care benefits. By investing in innovative solutions, UnitedHealthcare is working to make sure everyone can live a healthier, happier life.