Speaking The Language: Conversational Platforms In Healthcare

Conversation Platforms

Significant advancements related to conversation platforms and related technologies have occurred over the last several years.

- Plamen Petrov

New avenues have provided opportunities for businesses to serve customers more effectively and also reduce their operating costs. Conversational technology has seen increasing adoption across a wide range of industries including banking, telecommunications, healthcare, and finance.

Healthcare Business Landscape

Health plans sit in the center of a complex ecosystem, with various channels designed to communicate with each stakeholder group.

Health plan customers (patients) often need to reach out to their health insurance company (payer) for information regarding their plans. This specific information can be associated with their individual benefits, such as coverage eligibility, finding doctors, and claim reimbursement. Doctors and nurses also interface with payers for touchpoints like confirming coverage and negotiating payment through pre-authorization.

Payer investments catering to the needs of their constituent groups have yielded mixed results. Complex jargon/terminology and the maintenance of archaic technologies and solutions (e.g. mainframe databases) lend themselves to the difficulty in creating a comprehensive solution. As a result, customers often have a subpar consumer experience that would not be tolerated in other industries.

The Opportunity

Conversational technologies coupled with AI/cognitive computing technologies such as natural language processing/understanding engines (NLP/NLU) and machine learning techniques offer an avenue to address this challenge. While they are not all new, these technologies provide innovative ways of navigating the complexities that have historically constrained traditional rules-based software systems.