In the race to modernize health insurance, it’s easy to get distracted by the “shiny object” syndrome of Artificial Intelligence (AI). But as Elevance Health (formerly Anthem) recently shared in a Fierce Healthcare interview, the secret to successful AI integration isn’t the technology itself. It’s the strategy behind it.
For health plan leaders seeking to transition beyond pilot programs and into enterprise-wide transformation, Elevance’s approach provides an example of why execution matters. Here are six takeaways from their journey that you can apply to your organization.
1. Let the Member, Not the Tech, Drive the Goal
Elevance EVP Ratnakar Lavu notes that their digital innovation is guided by a simple mantra: Keep the member at the center.
The Tip: Before deploying a new AI tool, ask: “Does this solve a specific friction point for the patient?” Elevance uses AI in its Sydney app for real-time Spanish translation and personalized text alerts to close care gaps.
Action
Audit your member touchpoints. Don’t build an AI chatbot just to have one. Build it because your data shows members are struggling to find providers after hours.
2. Focus on Operational Quick Wins
While “curing cancer with AI” makes for a great headline, Elevance is finding value in the unsexy work of administrative efficiency. They utilize AI to generate call summaries in contact centers, freeing employees from manual data entry and enabling them to focus on the human aspect of member service.
The Tip: Start with internal workflows to build momentum and prove ROI.
Action
Identify high-volume, repetitive tasks—like claims triaging, call logging, or document collation. Automating these back-office functions provides immediate cost savings and prepares your staff for more complex AI integrations later.
3. Build a Responsible AI Guardrail Early
A lack of trust serves as one of the biggest hurdles to AI adoption in healthcare. Elevance addressed this by creating a Responsible AI Program. This framework ensures every AI application is audited for accountability, transparency, and data privacy.
The Tip: Don’t wait for a hallucination or a data bias issue to create your policy.
Action
Establish a cross-functional AI Ethics Committee that includes clinical, legal, and IT leaders. Ensure that every AI use case is explainable, meaning you can clearly document how the AI reached its conclusion.
4. Solve the Legacy Gap with Integration, Not Replacement
A major challenge for payers is integrating cutting-edge AI with decades-old core administration systems. Elevance’s strategy involves building foundations that allow data to flow across multiple touchpoints, whether that’s in their own app or at the provider’s office.
The Tip: You don’t always need a rip-and-replace of your core systems to use AI.
Action
Explore middleware translators and API connectors. By creating a bridge between your legacy data and your AI agents, you can leverage your patient history without the multi-year cost of a full system overhaul.
5. Upskill Your Workforce
Part of Elevance’s strategy included collaborating with OpenAI to provide AI skills training directly to their employees. Digital transformation often fails because of internal cultural resistance. Staff members often fear that automation means they’ll be replaced.
The Tip: Treat AI as an augmented intelligence tool rather than a replacement for human expertise. By investing in literacy programs, you turn your existing subject matter experts into AI power users.
Action
Launch a pilot-to-practitioner program. Identify department champions who best know your premium billing or claims workflows and train them to prompt and manage the AI tools in their specific domain. When the workforce feels empowered by the tech, adoption rates skyrocket.
6. Navigating Complex Clinical Cases
Elevance’s leadership is transparent about this reality: AI still has a “the jury is still out” status for complex care needs. For patients with multiple chronic conditions, the technology acts as a co-pilot, not a pilot.
The Tip: Maintain strict clinical oversight for decision-making. The goal is to determine how much AI can assist a clinician to the right outcome, rather than replacing the clinician’s judgment.
Action
Implement a Human-in-the-Loop (HITL) requirement for any AI output involving clinical outcomes or prior authorizations for complex care. Use the AI to surface insights from medical histories, but let licensed professionals provide the final sign-off.
Building for the Long Term
The roadmap provided by Elevance isn’t about winning a sprint. Instead, it’s about building a marathon-ready infrastructure. By focusing on integration over replacement and empowering your staff to work alongside these tools, your organization won’t just keep up with the digital curve—you’ll define it.
Certifi’s health insurance premium billing and payment solutions help healthcare payers improve member satisfaction while reducing administrative costs.
