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Humana joins with IBM Watson Health on AI tool

Humana is also working with CMS on a demonstration program for a hospice benefit for MA members.

Jeff Lagasse, Associate Editor

Humana and IBM Watson Health are joining forces on a new collaboration, one that will use IBM's conversational artificial intelligence platform to achieve greater clarity and transparency on benefits and other related matters for Humana Employer Group members. The goal, said Humana, is to provide a better member experience.

Research shows consumers who don't understand how their health plan works, or how to estimate out-of-pocket costs, are more likely to delay or avoid essential care. Watson Assistant for Health Benefits aims to help address this issue by leveraging conversational AI to streamline the engagements between agents, employers and Humana Employer Group members with clear and accurate information on benefits, healthcare costs and providers.

WHAT'S THE IMPACT

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The agreement stipulates that Humana will begin to deploy the tool, a virtual assistant that was built in the IBM Watson Health cloud. 

Initially, the service will be available to all of Humana's 1.3 million Employer Group medical members, and 1.8 million of Humana's Employer Group dental members. The solution utilizes a conversational virtual assistant with member benefits, coverage, claims, referrals and healthcare costs for Humana Employer Group members, agents and employer-customers. 

The objective is the creation of a cloud-native AI platform powered by IBM Watson with the conversational AI virtual assistant solution.

IBM Watson Health General Manager Paul Roma said an AI-enables conversational agent is trained to understand the logic of health plan benefits, and can help to simplify complex or confusing plan information.

The two companies ticked off some of the benefits of the Watson assistant. One way it helps, they said, was by addressing questions directly from members with speed, accuracy and personalized answers.

It can also help Humana employees and call center personnel answer questions quickly and accurately, helping to free up more time for customer care representatives to provide concierge-level customer service. It uses historical claims and provider data to calculate personalized cost estimates for medical services they said can help Humana members better manage their healthcare spending.

THE LARGER TREND

It's been a busy few days for Humana. Also this week, the insurer began evaluating a new way of offering hospice services to members of select Medicare Advantage plans in an attempt to provide greater continuity of care, additional transitional services and access to palliative support for patients with advanced illness.

As part of a four-year demonstration created by the Centers for Medicare and Medicaid Services, Humana's program is intended to help the company and CMS learn whether hospice services provided within the benefits package of Medicare results in additional innovation, enables a more seamless care continuum and improves quality and timely access to palliative and hospice care. Humana started offering the new benefit on select plans on January 1.

Humana is offering the hospice benefit to Medicare Advantage members enrolled in certain MA plans in Atlanta, Cleveland, Denver, the Louisville, Kentucky metro area (including Southern Indiana), and the Richmond-Tidewater region of Virginia. Humana has contracted with a preferred network of providers that are partnering on the delivery of additional benefits to support members during their hospice care.

As it stands now, when a patient with advanced illness who is receiving palliative care elects hospice, they move to a new care team based on the hospice provider selected. Under the demonstration model, Humana hopes to create continuity as members transition from advanced illness to palliative to hospice, ideally with the support of the same care team.

Patients electing hospice under fee-for-service coverage today have to forego all curative, transitional concurrent care, whereas the demonstration allows for transitional care to eliminate such an abrupt end to this care, and provide greater access to additional benefits.

The model also is designed to lengthen the time members are enrolled in hospice care, allowing them to remain in their home and avoid costly and often unnecessary hospitalizations near the end of life. More time in hospice means they and their families/caregivers can make full use of services that include alleviation of pain, bereavement planning, respite care, spiritual matters and other services. 

Under CMS guidelines, hospice benefits can last up to six months, but they can be continued indefinitely if the patient's condition remains terminal.

The demonstration continues through 2024, and Humana plans to expand the demonstration in 2022 to reach more members, pending approval from CMS in their annual application process.
 

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Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com