Smarter Care, Simpler Journeys: How AI Helps Improve the Consumer Experience

For a busy parent managing her child’s asthma or a retiree preparing for knee surgery, timely answers and proactive guidance can create a smoother, easier healthcare experience.

Artificial intelligence (AI) offers new ways to provide this type of support and tackle long-standing challenges in healthcare, from reducing paperwork to guiding people to the right care at the right time. By putting AI to work responsibly, we’re striving to simplify and personalize the healthcare journeys of the members we serve, allowing them to focus on the aspects of health and well-being that are most important to them.

Here's a look at three ways we’re using AI to partner with members of Elevance Health-affiliated plans on their path to better health.
 

Helping Members Get Answers Quickly and Conveniently

No one wants figuring out their healthcare to be like a scavenger hunt with scattered clues. They want a health plan that’s easy to understand, with clear answers about whether care is covered and how much it will cost.

Launched this year in the Sydney Health app, Virtual Assistant aims to simplify complex healthcare tasks to help people find the information and care they need as quickly and easily as possible. The AI-powered conversational tool can show members whether a medical visit or procedure is covered by their plan, where they can get care, and how much they can expect to pay.

Imagine a member named Jayson, who’s 48 and needs surgery for a hernia. He asks Virtual Assistant what his benefits will cover, and what the procedure might cost if performed by an in-network care provider.

Virtual Assistant can give Jayson:

• A list of nearby surgeons within his plan’s network.
• The estimated cost of the procedure for each physician.
• Details showing his plan covers hernia surgery at 30% coinsurance after he meets his deductible.

Virtual Assistant also can help Jayson view details like how much he’s spent toward his deductible. It can converse in Spanish, and complements the AI-driven personalized matching capabilities of our provider search feature, which is available online and within the Sydney Health app and helps members locate high-quality, lower-cost care.

Virtual Assistant is available for members of Elevance Health-affiliated commercial plans.
 

Making Healthcare More Proactive With Personalized Outreach

With the help of artificial intelligence, healthcare can shift from a reactive system to one that helps anticipate people’s individual health needs. We’re driving this type of transformation through an AI-driven outreach program used within Elevance Health-affiliated plans.

The program identifies health plan members who could benefit from proactive outreach that helps them address gaps in their care. That outreach — a reminder of a prescription due for a refill, for example, or a prompt that helps them schedule an annual wellness visit — can take the form of a personalized message that factors in a person’s health situation. While a text reminding an older adult that it’s time for an annual wellness visit can be important, for instance, that same reminder sent to a member who just got out of the hospital and is still recovering at home might be ill-timed and disconnected from their present circumstances.

In 2024, internal research indicates texting outreach through the program helped increase the rates at which identified members participated in annual wellness visits, completed colorectal cancer screenings, and achieved blood sugar control.

“By leveraging data and deploying technology in ways that work best for our members and are aligned with their needs and lifestyles, we can support their health journey in a more holistic way,” said Kyle Weber, vice president and chief strategy and transformation officer at Elevance Health.

Helping Our Associates Help Our Members

When a member reaches out with questions about healthcare services or their benefits, a suite of AI-driven tools aims to help call center associates have more time to focus on the member.

AI-backed assistance available to these associates includes:

“We’re equipping our associates with AI-driven tools so they can focus on each caller and respond with empathy, clarity, and respect,” said Ratnakar Lavu, chief digital and information officer at Elevance Health. “By helping to personalize care services and simplify complex healthcare processes, we believe AI can strengthen human connection and help drive better health outcomes.”