How a virtual assistant is helping to improve the member experience

How a virtual assistant is helping to improve the member experience

When Bianca Ramirez answers the phone in a UnitedHealthcare call center in San Antonio, she’s ready to support the member’s needs — without having to wade into plan details or scan through a series of individual records.

“Before it was a lot of searching yourself, having to keep scrolling to look for the information and drill down to what the member was looking for,” said Bianca, a UnitedHealthcare customer care advocate. “With AVA, it's allowed me to eliminate the research part of it and just take the member's feedback and be more engaged.”

Bianca can streamline the process, thanks to a virtual assistant powered by artificial intelligence (AI) technology. Agent Virtual Assistant, also known as AVA, is a chatbot capability created by Optum that has been rolled out nationwide to help improve the customer service experience, enabling UnitedHealthcare advocates to provide members more information about their benefits and answer questions faster.

“Behind the scenes, AVA is pulling data in for each specific member who calls, everything from previous claims to resources that may be able support the individual’s path toward health,” said Nia’be Mitchell, vice president of member experience and implementation at UnitedHealthcare. “What’s excellent is that the advocate is not having to navigate through multiple systems to pull the data. AVA is doing that for them.”

Using the virtual-assistant capability, AVA can supply answers to basic questions in just seconds. Advocates can also use information provided by AVA to recommend available wellness programs or suggest cost-saving measures, such as virtual care for common medical issues.

“If a member says, ‘Oh, I just think I might have pink eye,’ that’s something where you could use a virtual visit,” Bianca said. “The member may not have utilized that before, and they might have otherwise gone to their doctor's office and possibly paid a higher copay.”

AVA’s work continues even after the call ends. The software creates a summary of the conversation, enabling an advocate to follow up with a member to:

  • Stress important details that were discussed
  • Offer clarification that may be necessary
  • Suggest possible next steps

“We want to help that member at significant points in their journey to improve health outcomes — and, when possible, reduce costs for the individual, their employer and the health system more broadly,” Nia’be said. “To achieve all those goals, we need technology like AVA in place.”

AVA is just one of the innovation resources being integrated across UnitedHealthcare to help improve the member experience, the outcome of an annual investment of more than $5 billion in data and technology. 

“Individually, these resources are good,” Nia’be said. “When we put them together and have them interact, they become great.”

For more information about AVA and other AI capabilities that are helping the health system work better for everyone, visit uhc.com.