UPMC Health Plan Virtual Assistant Aims to Improve Access to Care

The University of Pittsburgh Medical Center (UPMC) Health Plan has launched a virtual tool to assist members with questions about benefits, coverage, services, and access to care.

The health plan’s virtual concierge is available to members 24/7. It provides voice assistant responses to users’ questions as well as links via text message if more help is needed, according to the press release.

The tool can assist with common questions on topics such as benefits and coverage, explanations of insurance terminology, how to access services like UPMC’s telehealth mobile app, services for new UPMC Health Plan members, and information about the COVID-19 vaccine.

“The virtual concierge is another way UPMC Health Plan is making health care more accessible for our members,” said Chris Daley, director of digital technology services for UPMC Health Plan.

“This useful, easy-to-use, and fun resource reflects our commitment to both exceptional service and innovation.”

The virtual concierge is available on technologies that can use either Amazon Alexa or Google Assistant. After activating the tool with a verbal prompt, members can then ask questions out loud to their speakers and the system will respond.

The payer designed this solution in direct response to member feedback. In a past UPMC Health Plan study, 40 percent of Pennsylvanians surveyed said that a “smart speaker” voice assistant would help them better understand their insurance benefits.

Other payers have implemented similar voice-activated artificial intelligence assistants as well.

UPMC Health Plan’s announcement represents the next step in its efforts to improve member experience. Previously, the payer implemented initiatives to address members’ social determinants of health. With access to more patient data, the payer was able to provide better, individualized support to members and improve its member engagement capabilities.

The ability to assess members’ needs and respond quickly is crucial to successful member engagement. Payers have historically performed poorly on patient satisfaction surveys. Experts have indicated that flawed communication contributes to that outcomes and that by partnering with members payers can achieve better results.

Perhaps as a testament to the usefulness of voice-activated artificial intelligence assistants in member engagement, other payers have implemented similar solutions as well.

For example, Anthem Blue Cross Blue Shield in Ohio developed Anthem Skill to improve member engagement and medication adherence.

Anthem Skill uses Alexa to answer questions about account finances such as balance inquiries, deductibles, and out-of-pocket spending. It can also assist with acquiring a member identification card and scheduling an appointment with member resources.

“We work every day to create data-driven, simple, and personal health care experience for our members,” said Steve Martenet, president of Anthem Blue Cross and Blue Shield in Ohio.

“Expectations have evolved and people want secure and easy-to-use access to their health information across multiple devices including phones, tablets, computers and virtual assistants. Enhancing the Anthem skill for Alexa is just the latest step in our digital-first approach to healthcare.”

Humana, partnering with IBM Watson Health, also developed an artificial intelligence-enabled virtual assistant.

The assistant provides information on benefits, costs, and providers to not only plan members but agents and employers, too.

“Navigating our health coverage without the right support can potentially serve as a barrier to care,” Paul Roma, general manager at IBM Watson Health, said.

“An AI-enabled conversational agent that is trained to understand health plan benefits logic can play a role in helping to simplify complex or possibly confusing plan information. We are proud to support Humana in leading the effort to deploy conversational AI to help enhance and improve the consumer experience.”

The payer was also hopeful that the artificial intelligence tool would help reduce members’ healthcare spending by helping them predict their healthcare costs.