Founded in 1853, Aetna is one of the nation's largest providers of healthcare benefits, serving over 40 million members in all 50 states. Its network includes more than 5,400 hospitals, more than 597,000 primary care doctors and specialists and more than one million healthcare professionals.
Aetna is a company of more than 36,000 employees, over 16% of which are in customer services roles. Aetna Navigator®, Aetna's secure member website, was generating a large number of routine questions from members registering or signing-in to the site. Although customers oftentimes experience difficulty with log-in or registration for secure sites due to password recall or other reasons, privacy and HIPAA regulations required Aetna to create a multiple-step authentication process. This was particularly challenging early in the year when many Aetna health plan members start to use their new benefits and visit the website to register for the first time. Those unable to register or having difficulty were picking up the phone for help, incurring call-center costs for Aetna—money that could be better spent delivering health services.
Additionally, Aetna wanted their members to have access to assistance after call center hours, including evenings, weekends and holidays.
In its mission statement, Aetna states that it is "dedicated to helping people achieve health and financial security by providing easy access to safe, cost-effective, high-quality healthcare, and protecting their finances against health-related risks." The company strives for all interactions to be accessible, simple and clear. It focuses on providing the right information at the right time to help people make better decisions.
Toward that end, Aetna's leadership wanted a way to cost-effectively help its members right where they were—on the web—without sacrificing quality of service or accuracy.
Aetna decided to execute its initial implementation of the Alme natural language platform from Next IT on the registration pages of their site, where an intelligent virtual assistant could provide the most immediate help to new members visiting the site for the first time.
Ann, Aetna's intelligent virtual assistant, debuted in early 2010 when many new members were first beginning to use their plans. Ann is available to members 24/7, making it easier to do business over the web. Members are able to type in their questions, using their own natural language, and get the information they need to continue registration. Ann can answer if a healthcare procedure is covered, or if the provider is in the member’s preferred network. When members ask Ann about costs, Ann connects members with the Member Payment Estimator, which can answer how much a procedure will cost and can even compare costs by facility or physician.
The results show she's having an impact. More than half of people registering on the website for the first time engage with Ann. And, because Ann does such a good job walking members through registration, Aetna reported that during the fifth month after implementation, they saw a 29% reduction in calls to their member-service technical help desk. Members who utilized the Member Payment Estimator saved as much as $170 of out-of-pocket costs. This extra level of efficient member service means that Aetna is seeing a reduction in operating expenses while still providing the exceptional service that members expect.