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At Anthem, AI Customizes Consumer Health Care

An AI-first mindset enables the company to tailor data-driven insights to individuals and treat each health care consumer as a population of one.

Rajeev Ronanki
Rajeev Ronanki

Digital technology is fundamentally transforming the way we interact with the world. People, machines, data, and processes are becoming increasingly connected, and the result is an explosion of information that can be used to understand customer needs. Yet the sheer volume of data and data sources required to get us where we need to go has exceeded the pace and scale of our human capacity to process it. Enter AI. Poised to lead the next wave of exponential change disrupting health care, AI can mobilize analytics and automation to deliver moments that matter. The winners in the health care industry will be those organizations that not only empower patients to own their health data but also use AI to generate actionable insights in real time to drive engagement and outcomes.

Our multidimensional digital transformation strategy and AI-first mindset help us treat every individual as a population of one. Our first step was to stand up a platform-based AI engine rather than point-to-point data solutions. We invested heavily over the years in our underlying data management capabilities as a foundation for this transformation. For example, our data infrastructure was already able to process both structured and unstructured data, feeding and curating our data pipeline and continually governing and certifying the data. Next was implementing data governance, security, and a trusted layer around the data stores. We added machine learning engines, algorithm layers, and software development kits, which facilitated building out APIs for portal, mobile, and internal channels. And we built feedback mechanisms allowing our AI to evolve from gathering data to providing insights to prompting actions—automating and speeding up processes and continuously learning from the feedback to improve future interactions.


Also critical to realizing the full potential of AI across Anthem was gaining enterprisewide support for the initiative, which meant conceptualizing with our stakeholders the positive business outcomes we could achieve. We asked our business partners for input on how we could use AI to rethink, reimagine, and re-implement across core business processes. Initially, we focused on automating data processing and analysis where AI could have the biggest effect on our business: serving customers more efficiently. The team identified operational functions, including claims adjudication, prior authorization of procedures, provider payments, and consumer/customer billing functions as the top choices for the initial pilot programs. We built a proof of concept for each and, if the application provided value, doubled down to scale it, applying agile techniques, and pushed the process into production.

Finally, to execute on our vision for AI throughout Anthem, we knew we needed to be proactive in broadening our talent base. So we created Anthem AI to attract skilled technologists and cultivate existing internal talent by offering a structured AI training program. The unit works to retain that talent by building a culture that promotes innovation and ideation of AI solutions for the business.

Currently, AI is just one technology fueling our digital transformation across the enterprise. One of our recent projects is a yearlong data trial to test whether blockchain and precision medicine, along with AI, can predict when people will experience allergies. The hope is that our predictive model can add accuracy, speed, and cost-effectiveness to health-related insights.

One thing we’ve learned from this journey is to do away with the notion of starting with a greenfield. Instead, we see how AI can affect business outcomes, then connect related, fit-for-purpose use cases to achieve small wins. By approaching AI and machine learning with a process-level view, we’ve been able to deploy next-generation technology in a way that significantly improves our customers’ experiences.

—by Rajeev Ronanki, chief digital officer, Anthem

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