Preparing for an AI future in health insurance

How do you build a foundation for AI-driven connected experiences in a nonprofit health insurance organization? Just ask Brian Kopp, Associate Director of Digital Transformation for Minnesota-based UCare, which offers health insurance plans to 600,000 members.

Working with Sitecore Platinum Partner Horizontal Digital, UCare recently completed a strategy exercise that resulted in an exciting vision for the future: UCare wants to ensure that its people-powered health plans are delivered by AI-enabled people-first experiences. At Sitecore Symposium 2024, Kopp outlined the key steps of the engagement that produced the organization’s vision and multiyear roadmap.

“As a nonprofit payor, UCare’s mission is to improve the health of our members. We work to decomplicate, advocate, and go the extra mile to help people,” Kopp said to an attentive live audience. “To support our desire for growth, while continuing to deliver on our mission, we need digital solutions that can help us scale.” Rather than replace people with technology, the organization aims to enhance interactions, by digitizing the human experience that sets UCare apart from its competition.

To drive change for the future, UCare needed to bring cross-functional teams together to raise awareness and increase collaboration. Accordingly, the project began with stakeholder interviews to learn what goes on behind the scenes, followed by a digital transformation maturity assessment. “We needed to understand where we are today in order to know where we want to go,” Kopp explained.

Connecting siloed data

Like many healthcare organizations, UCare has a long list of different technology systems, resulting in siloed data that isn’t shared across departments except by manual exports and imports. The Horizontal team helped UCare see a path to connect all that information and create unified profiles of its members.

Steps to success

According to Horizontal Digital, moving through levels of digital transformation maturity involves integrating systems and data sources across the payor ecosystem, which enables capabilities to perform omnichannel, hyper-personalized, data-driven, and AI-assisted marketing, sales, and service. The idea is to take stock of the how the organization is operating currently and move through three levels of the process:

• Level 1: Digitally supported traditional processes.
• Level 2: Coordinate digital operations.
• Level 3: Intelligent digital business functionality and innovation.

“If you look at your stack, you already have AI in a lot of your tools. The problem is, if you don’t put the data in the middle and do the necessary integrations, you can’t make the AI work well,” said Horizontal founder Chris Staley. By connecting the dots between people, technology, data, and processes, UCare believes it will be able to deliver human-centric, connected experiences that live up to its people-first brand promise.

UCare wants to understand its members and be able to grow with them,” said Staley. “And the end goal is to get to a point where UCare anticipates members’ needs and can take action proactively before the members think of it.” AI is not a magic wand, Staley added, but it can be a powerful tool that can revolutionize the business by helping to improve customer service, marketing, and more.

Staley outlined four sample use cases for AI in this context:

1. Personalization: AI can analyze data to create personalized recommendations, content, and interactions for customers.
2. Adapting to customer expectations: AI can help brands understand how to interact with customers across different channels and adapt to changing expectations.
3. Innovation: AI can help organizations innovate faster and create connected experiences for customers.
4. Customer service: AI chatbots can use natural language processing (NLP) to understand customers and provide feedback.

By the end of the engagement with Horizontal, UCare had looked closely at the “onstage” elements of user experience, visual design, content and functionality – as well as the “backstage” factors of people, processes, tools, and data that need to work in harmony to drive the end user experience.

The resulting architecture showed how UCare could integrate Sitecore’s XM Cloud, Personalize, and Content Hub solutions with existing Sales and Service CRMs as well as native apps, using a Customer Data Center (CDP) in the center to tie all the various systems together.

Kopp concluded the Symposium presentation by walking through a diagram of UCare’s Connected Experience and touching on the layers of Design System, Integrations, Personalization, and Omnichannel Orchestration, arriving finally at AI and machine learning. “We’re not ready to implement AI yet,” he said, “but we are starting internal conversations with marketing, sales, and IT to define what AI means for UCare, what the use cases are, and how we will use the technology to drive business value.”

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