Nevada: Like it or not, AI has reached the first ACA state-based marketplace

Honestly not sure how to feel about this, but it was inevitable...

via Nevada Health Link:

Nevada Health Link Spearheads AI Implementation, Championing Cutting-Edge Technology for Unparalleled Consumer Engagement

  • The first State Based Marketplace to receive Centers for Medicare & Medicaid Services approval for implementing AI technology

MOUNTAIN VIEW, Calif. – In a groundbreaking move towards enhancing consumer experiences and setting new standards in health insurance exchange technology, Nevada Health Link proudly announces the successful integration of Artificial Intelligence (AI) into its State-Based Marketplace (SBM) platform. This first-of-its-kind initiative underscores Nevada Health Links's unwavering commitment to innovation, transparency, and consumer-centric strategies.

The implementation of a purpose-built interactive virtual agent (IVA) by the team at GetInsured marks a significant milestone in Nevada Health Links's journey. Nevada Health Link is the first marketplace to have Centers for Medicare & Medicaid Service’s (CMS) approval for the use of AI-based Interactive Virtual Agents to enhance the customer service experience. The state worked collaboratively with the CMS and GetInsured security teams for several months to ensure that all federal privacy and security requirements were met. This approval signifies a high level of confidence in the technology that the marketplace has implemented.

"The successful integration of AI into Nevada Health Link, facilitated through collaboration with GetInsured, showcases Nevada's commitment to employing cutting- edge technology to serve its residents more effectively,” said Tim Galluzi, State Chief Information Officer, Office of the Chief Information Officer (OCIO). “At the OCIO, we applaud all our partner agencies advancing the technology that impacts service delivery to Nevadans and this initiative highlights ongoing pursuit of excellence in leveraging technology to meet the evolving needs of Nevadans.”

This AI-driven innovation offers callers natural language interactions that answer common questions and requests instantaneously, augmenting the call center’s normal business hours by operating round-the-clock support to individuals seeking help with basic needs such as password resets and finding enrollment assistance.

"Given the prevalence of gig workers and individuals with unconventional work schedules in Nevada's diverse workforce, the integration of AI into the Nevada Health Link platform ensures that essential support is available round-the-clock,” said Russell Cook, Executive Director of Nevada Health Link. “This cutting-edge technology caters to their needs, offering seamless assistance to individuals seeking information or help at any hour. The AI technology increases the call center capacity by streamlining consumer interactions, reducing peak call volumes, and allowing Customer Service Representatives to focus on complex queries."

During Plan Year 2024 Open Enrollment Period, roughly 2,700 calls, or 14.5%, were fulfilled entirely by the virtual agent. Additionally, 2,100 calls, or 9.6%, were automatically transferred, predominantly to affiliated brokers or Nevada Medicaid, as appropriate. The IVA freed frontline workers from these task-based calls, which mainly consisted of resetting usernames or passwords, activating accounts, unlocking accounts, uploading documents, and assisting with enrollment cancellations allowing workers to focus on complex tasks while reducing the time a customer had to wait for specialized services.

“Our relationship with Nevada Health Link began when we transitioned it off of the federal marketplace,, in 2019 and has grown over the years,” said Chini Krishnan, Founder and CEO at GetInsured. “The incorporation of AI stands as a testament to our strong teamwork and Nevada's resolute dedication to providing cost- effective solutions, enriching consumer interactions, and amplifying state oversight over health care initiatives."

Nevada Health Link concluded its Open Enrollment Period on January 15, with a significant uptick in enrollments compared to the previous year. A total of 99,312 Nevadans signed up for Qualified Health Plans and 20,984 for Qualified Dental Plans, representing the second-largest enrollment in the state's marketplace history. Of the total enrollments, 25,553 were new enrollees, while 22,965 existing plan holders actively shopped to upgrade or switch plans during the enrollment period. By leveraging AI capabilities, Nevada Health Link gained valuable insights into customer behavior and preferences, paving the way for data-driven decision-making and improved service personalization.