It seems like a week doesn’t go by without Amazon making news in healthcare. Most recently, the tech giant announced that Alexa, its AI-driven voice assistant, now has HIPAA-compliant features. This will enable consumers to access their individual health information via voice command in a manner that complies with U.S. health privacy laws.
Many of Alexa’s use cases are episodic in nature, such as scheduling an appointment or checking the status of a prescription delivery. While these benefits are significant for patients at home, Alexa’s new features have implications for health organizations, too. According to Amazon, the voice assistant program has launched within six healthcare entities that include two hospital systems, a diabetes-focused digital health firm, a PBM and a national health plan (Cigna). In fact, Cigna is testing an Alexa voice program with its largest employer-group clients, allowing employees of these groups to use the voice program to manage their wellness goals and earn targeted incentives.
The Alexa move is similar in aims to that of Aetna's Attain app and speaks to the “platform revolution” that’s underway with major health plans.
In the highly competitive and low-growth employer segment, health plans are looking for ways to collect and integrate old and new data into an infrastructure that drives a better member experience and reduces the cost of care. Getting this right for a company like Cigna is critical: More than 80% of its total members reside with larger employer groups. According to Cigna’s annual report, large self-funded employers also were Cigna’s lowest-growth segment measured by membership in 2018.
Unlike Medicare Advantage, which has enjoyed market growth of nearly double-digit percentage points, the large group space is a dog fight. Most large employer plans go out to re-bid every three to four years, and with unemployment rates at historic lows, growing membership is tightly linked to acquiring or retaining employer clients.
What’s more, there are dozens of large companies looking to circumvent the role of health plans in benefit design and contracting, such as the Health Transformation Alliance and GM contracting directly with Henry Ford Health System. A fully integrated health plan platform has the potential to deliver end-to-end member engagement and enable plans to differentiate themselves through analytics.
For the platform revolution to succeed, use case design must be informed by deep member insights to demonstrate early success. This brings me back to this specific use case with large employers. While the motivations and strategic imperative may be sound, I’m worried that using Alexa for “high-tech wellness” will deliver muted results.
Why? I see three challenges related to targeting and execution:
1. The right member demographics: While Cigna is highly over-indexed with members within employer groups, there’s reason to believe that the Medicare population may be a better fit for AI-driven applications. ZS’s AI in Healthcare study revealed that seniors were more likely to say that they’re open to the use of AI in healthcare than younger populations, and were more willing to share their medical records and prescription history through AI. More than half of those surveyed under the age of 65 are already using mobile health apps or wearables, but will it become a burden to report results to a stationary in-home device?
2. An applicable use case: ZS’s survey also showed that 63% of consumers were more comfortable with AI playing a role with administrative tasks—such as scheduling appointments and setting up medication reminders—versus more in-depth tasks. The other five use cases described appear to be far more palatable in this regard. They can attract a new user when they are most engaged (such as after a service). For example, Express Scripts allows patients to use Alexa to check the status of an at-home prescription delivery. In doing so, Express Scripts targets a captive audience (those who are waiting for a prescription) in the right setting (their home).
3. A programmatic approach to adoption: Even if the targeting was spot-on with the perfect use case, driving actual behavior change is still a difficult task. It’s exceedingly challenging for a large employer spread across multiple sites to both create meaningful awareness and provide ample enough incentives to sustain usage.
There’s no doubt that AI-driven applications are here to stay within all subsectors of healthcare. There’s also no doubt that health plans face threats in growing and sustaining their membership, especially within the employer segment.
While incorporating technology in healthcare is only one step within a much larger journey, health plans should remember to focus their AI efforts where it will resonate the most.