Health Insurers Turn to Smart Apps to Cure the Epidemic of Non-Compliance

March 22, 2017

Getting patients to take their medicine has plagued the medical profession for quite some time. Unfortunately, it isn’t as simple as having them take it with a spoonful of sugar, as Mary Poppins advised.

And it’s not just medical professionals and patients who suffer. In today’s highly regulated insurance environment, this issue has also become a critical concern for insurers – now being held accountable for patient outcomes, and hit with Medicaid and Medicare Advantage fines for patient non-adherence.

Why are such a significant number of patients missing their prescribed medications – or as an article on Medscape puts it, why is there an epidemic of non-compliance? There are many factors that contribute to the problem – forgetfulness, uncertainty of how and when to take medicine, ambivalence about taking the medicine in the first place, and costs

Bots to the Rescue

Technology is stepping in to provide a cost-effective solution to the problem. Chatbots, which incorporate machine learning to “listen to” and “respond to” human conversation by voice or by text, are giving insurers a new communication channel for reaching their customers.

Many are using these chatty artificial intelligence apps, or smart apps as we call them, to efficiently remind patients to take their medications, not only eliminating the challenge of having to staff 24/7 call centers to make outbound calls, but also freeing up staff time to focus on other issues. In addition, chatbots are being deployed by insurers to answer customer service questions about pre-approvals and other issues.

Your Secrets are Safe with Chatbots

The security of chatbots has matured to make it a very attractive option. The chatbots we’re developing for clients built on the Microsoft Azure platform provide a high degree of data security that complies with HIPPA requirements and industry best practices.

Additionally, every interaction with a chatbot is logged, and the identity of the patient is validated before any information is provided. In fact, this rules-based app most likely provides a higher degree of security than a human at a call center – you could never “convince” a chatbot to give you information that it is not authorized to provide.

Making Chatbots Even Smarter

Now imagine if you could not only communicate cost-effectively with patients using chatbots, but you could also easily determine whom you should contact and what issues need to be addressed.

That’s the exciting new possibility that is available when you combine chatbots with cognitive solutions such as Robotic Process Automation (RPA), a form of artificial intelligence that automates repetitive manual tasks.

Using RPA, insurers can easily identify customers with specific conditions, such as heart problems and diabetes, that require vigilance in taking prescribed medicine. Seeing patterns, they can flag those who are late in refilling or picking up their medications.

Taking it one step further, RPA technology can look for customers who fall within the specified time limit that the insurer is required to meet before a fine gets levied, so the company can focus on those calls that will also have the greatest financial impact. Imagine if all this information is seamlessly provided to the chatbot, which can then conduct outbound calls to the customers.

Teaming up with smart technologies, such as chatbots and RPA, insurers are not only addressing one of their most critical challenges — ensuring patient adherence, but also improving patient outcomes. A win-win for patients, providers and insurers alike.

 

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