According to a recent study by JD Power, 30 percent of commercial health plan members view their insurer as a trusted partner in their health and wellness. Health insurers are investing significantly in digital tools. A good share of those resources typically goes towards chatbots, robotic process automation and self-service portals built for easy navigation.

Unlocking the full value of this investment has less to do with the scale of investment and more to do with the way it has been deployed. Call centers, prior authorization units, claims operations and compliance teams have automated their own functions independently, often through different vendors with no shared view of the member or case underway. Friction concentrates at the handoffs, the points where coordination matters the most.

Member services teams typically receive a steady stream of repetitive calls about claims status, eligibility and coverage; the same calls that interactive voice response systems and web portals were meant to reduce or eliminate. Prior authorization often causes friction for physicians and patients alike. A recent American Medical Association survey of 1,000 practicing physicians found that prior authorization consumes an average of 13 hours of physician and staff time each week, and 95 percent said it delays access to necessary care.

Care transitions stall too. Documentation does not always follow the patient from one system into the next. By the time compliance teams notice, they are often the ones stuck closing gaps that formed somewhere earlier in the chain.

Traditional automation was not built to do more than execute discrete tasks, and it largely performs that part reliably.

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