Covered California (www.CoveredCA.com) is the largest health exchange in the U.S. As an independent part of the state government, the organization works in close partnership with the California Department of Health Care Services. Through Covered California, more than two million state residents renew or enroll for affordable health and dental insurance under the Patient Protection and Affordable Care Act or through the state’s Medi-Cal program. The organization’s Enrollment Partner Portal helps more than 5,000 insurance agents and enrollment counselors by automating previously manual processes, including allowing enrollment partners to complete applications and certifications online.
With such a large population, consumer needs were highly variable and unpredictable. Scaling up to handle call volume and variability, solve problems, and issue health insurance before the deadline during the annual health insurance open enrollment was an annual challenge. Covered California’s leaders needed a way to reduce call volume so the organization could avoid hiring seasonal call center employees while also providing better customer service with extended support hours.
The KPMG team architected and implemented a virtual assistant, CiCi, using agile methodology and a cloud-based machine learning and artificial intelligence platform. KPMG’s natural language processing framework allows CiCi to understand human queries and find best possible answers.
We also guided the client to understand new insights from the data the assistant collected, such as usage trends, unanswered questions, and user sentiments during their chat interaction. Further, KPMG provided a user-friendly, self-service productivity tool to the Covered California team to simplify training the virtual assistant.
Within a four-month timeframe during the 2019 open enrollment period, CiCi responded to more than 111,000 user questions and constantly evolved responses based on its artificial intelligence training. The user-friendly self-service channel answered Californians’ common questions in real-time, reduced response time, and offered around-the-clock service. CiCi also helped decrease call volume, which enabled Covered California to reduce the seasonal call center workload needs to handle open enrollment.
KPMG architected and implemented CiCi, Covered California’s intelligent virtual assistant, for 2019 open enrollment. The virtual assistant runs on the Microsoft Cortana and Microsoft Cloud platforms and integrates with other back-office platforms like identity, ruled engine, and interactive voice response.
CiCi continues to provide Californians 24x7 answers to more than 90 commonly asked questions in English and Spanish. Using natural language processing, CiCi understands questions and provides predefined responses based on the query intent such as password assistance and open enrollment dates. It allows consumers an additional assistance channel, especially valuable near open enrollment deadlines when telephone help wait times can be lengthy.
KPMG also guided the Covered California team to understand and use new insights the virtual assistant data provided to determine if they improved the user experience as well as identify consumers’ intentions and satisfaction levels for those using CiCi. Further, we defined a process for content governance to maintain information quality while following agile change management.
Finally, KPMG team created a future roadmap to enrich the virtual assistant piloted for 2019 enrollment with more answers and services such as password resets and creating the 1095 form for a more effective open enrollment. The assistant also has the capability to add languages as needed.
Working with the Covered California team, we took the initiative to approach the organization’s leaders to better understand the challenges and priorities before sharing our implementation roadmap and recommendations. We listened to the client’s needs and responded with the best-fit platform and resources that will scale as future needs grow.
We brought together a team with a wide range of skills and experience including intelligent automation, health and government, and customer solutions to respond to Covered California’s unique challenges. Our deep experience working with natural language processing in regulated environments helped lower risk, and our broad alliance ecosystem provided multiple platform options for the virtual assistant.
The KPMG team is equipped with experience working with other states and commercial clients around the world that face similar challenges.
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