Elevance Health offers artificial intelligence-powered digital concierge care to just under 5,000 members today in an effort to provide meaningful, personalized care for members with chronic conditions such as diabetes, Crohn's disease and long COVID.
Becker's sat down with Anthony Nguyen, MD, chief clinical officer at Elevance Health, to discuss the company's plans to expand its concierge care program to 40,000 members by the end of 2023. He said the goal is to eventually expand the program to all 48 million members nationwide.
Editor's note: Responses were lightly edited for length and clarity.
Q: What's the history of this program and why is there a need for it?
Dr. Anthony Nguyen: This rolled out a couple years ago and it stemmed from a need to do care management in a different manner. Unlike other programs that are mostly telephonic, we wanted to really transform how we can engage with our members in a way that is more personalized.
We also wanted this to be much more engaging, similar to any of those other social media companies out there. And finally, we wanted content that's meaningful and not just generic videos about diabetes for example. Let's put stuff that the member as an individual might be interested in. We curate the feed with care management support and educational opportunities, and then gamify it as well.
The program initially started with a disease-specific approach for Crohn's disease, where the provider would prescribe the app to the member. As we expand out, it's been logistically difficult to have every doctor prescribe the app, so we've been going direct to consumer ourselves. With time, we hope to be able to make this available not only direct to consumers, but also white label it for providers to be able to offer it to their patients as well.
More than 2,000 members are using the app for Type 2 diabetes. As we roll out to 40,000, the program is going to be more disease agnostic because members can have multiple conditions.
Q: How is Elevance Health anticipating this program to be used across so many different members and geographies?
AN: We have a patent pending, which we've dubbed nurse match. Our nurses have voluntarily taken personality tests so that we can then match to somebody the patient trusts. From the patent, we've used our AI to aggregate information that's already within our four walls (and sometimes outside of), including information about claims data or doctors that you visit.
We can infer what type of personality the patient is and then we have a match. It's not all the time because licensure is important within each state, but we want to be able to match you so that the nurse can then engage with you. Once there's trust, they can build upon that and have a good interactive coaching experience.
Q: On the ground, what are some of the results you've seen among members so far?
AN: We've seen a 39 percent reduction in ER utilization and 25 percent improvement in disease symptoms for things like Crohn's disease. Our Net Promoter Score score has also increased from the 60s to the 80s.
Q: From a broad clinical perspective, where do you think AI is going to have the biggest impact on health plans and members moving forward?
AN: We're cautiously optimistic about AI because it can be used for many instances, good and bad. One of the areas we demonstrated that AI can be used in a positive way is to personalize content, as well as anticipate the needs of our members. In addition to concierge care, we are actively working on identifying content and serving up information that's relevant to members.
Part of our focus at Elevance is simplifying the experience that people have throughout the healthcare system. AI could be used to bundle things. For instance, with a hip replacement we would be able to identify everything a member might need downstream for that episode of care — maybe it's physical therapy, maybe it's a follow-up imaging test. Bundled together, we can approve the hip replacement and all these other things, too.
Q: How does the concierge care program play into Elevance Health's broader strategy of growing in home care capabilities?
AN: In short, it's about enabling and empowering our members to age successfully in the home. That means having technology as a critical partner in terms of helping people in the home, but also the services. That's where Carelon comes in with a broad suite of services in the home to help people age appropriately.