Elevance Health is a lifetime, trusted health partner whose purpose is to improve the health of humanity. The company, which serves approximately 104 million customers, supports consumers, families and communities across the entire health care journey—connecting them to the care, support and resources they need to lead better lives.

How is Elevance Health defragmenting the health care to give patients and providers the longitudinal coordination and insights for better experiences?

We are leveraging digital technologies and artificial intelligence to enhance the health care experience for the people we have the privilege to serve.

For consumers, this means simplifying and personalizing the member experience. For care providers, this shows up as supporting them with reduced administrative burden and helping them provide higher quality, more proactive care. And for our associates, it is equipping them with AI-enabled tools to help them deliver higher quality services.

Oftentimes, people have to go to multiple entities within the health care ecosystem to get care, which can be confusing and complicated. With the experience of serving more than 100 million consumers, we see the opportunity to simplify the health care journey and help people lead healthier lives. As such, we are building capabilities to personalize experiences and provide people with the right information, when they need it, to make the right decisions for their care.

For example, we launched an artificial intelligence-enabled virtual assistant on our Sydney Health application. A member can ask, “Is my knee surgery covered?” In response, the app will look at the individual’s benefits and provide an in-context answer that includes their financial responsibility. Sydney will also connect the member with the right high-quality, cost-effective providers for the particular surgery needed.

In order to enhance the health care journey, we also have to simplify interactions with the provider ecosystem. This helps reduce administrative burden for the provider so they can focus more on delivering patient care.

Our associates also help drive a better health care experience when they serve members, care providers and various stakeholders with the AI-enabled tools, data-driven insights and more relevant information serviced by technology. This enables deeper, more empathetic conversations with the people we serve.

How do you connect providers when they are outside Elevance Health’s organization?

Health care generates a ton of data, but the data is siloed. Providers have one set of data, we have another and labs have another. We are able to create a longitudinal view of the members we serve by pulling together the health information we have on them and connect that data from other players in the health care ecosystem, including electronic medical record (EMR) platforms, including Epic and others, providers, specialty clinics, pharmacies and urgent care facilities. This is extremely important because many entities within the health care system cannot connect the dots because patients go to multiple providers.

We are unique in actually collecting all of that information, looking at the member’s longitudinal record and applying AI to it. One example is our AI-assisted Proactive Member Engagement program. Most health care is traditionally reactive, but with Proactive Member Engagement, we are being more proactive and appropriately reaching out to patients and providers to suggest next best actions. With this program, we sent out 12 million-plus messages to our members in 2025.

How do you get buy-in from people who want a human, only trust a certain doctor or have trouble navigating AI?

We want to be able to provide the best empathetic service, no matter what the touch point is. Some users will leverage our app, while others will want to just use text messaging and others want to call to address their questions. We want to make members’ AI-enabled experience as seamless as possible. Members should not even feel the AI that powers Elevance Health’s services from deep underneath. For example, someone who needs to maintain their blood pressure could arrange to receive text notifications but not know or realize that is enabled by an AI-enabled program.

The associates running our call center now have a unified desktop. When a member’s call comes in, we put their whole record through AI-enabled programs to synthesize all the information and present relevant information to the associates. This means associates do not have to spend as much time going through pages of information across multiple systems. This translates to associates having more time for conversations with members about their health.

I think people will be more likely to buy into this technology when they see firsthand how it helps them have an enhanced health care experience.

What kind of feedback are you getting after deploying solutions such as Sydney Health and AI-driven outreach?

The responses we have received show us that we have been able to help people get what they need.

Sydney Health’s virtual assistant is something our members really love. Nine out of 10 people do not call us back because we are effectively servicing them and answering their questions there at the point of interaction. With these initiatives, we ask whether we addressed what they were contacting us for and whether we actually provided them the right information for the right outcomes.

How do you overcome the differences in collection and confidentiality issues to bring many different data sets all together?

We take data privacy and data protection extremely seriously. Protected health information is where our transparent and responsible AI framework comes into play. From the moment we think about designing a capability to post-production, we want to make sure no bias or hallucination was introduced during the process. We have a robust framework that tests for these risks pre- and post-implementation. We will check, log, audit and gain complete insights into how AI helps make decisions, building trust in the reliability of the information people get from us.

Does the company have any mitigation plans in place in case something does go wrong, particularly with AI?

We have been very intentional about the critical decision about where and where not to use AI. For example, we may want to use AI to help guide prior authorization approvals. But sometimes, the information provided is not enough to lead to an approval. In these cases, we want a human associate to determine what the decision should be.

Additionally, our Elevance Health AI platform of registered AI and AI agents helps us ensure AI does not deviate from its guardrails. Everything that goes into production is also audited on a regular basis by humans to help make sure nothing bad is happening within the ecosystem overall.

Looking forward, in the next couple of years, what are some goals for facilitating digital transformation, strengthening tools and making human impact?

We are done with proof of concept with much of our work and are building capabilities at scale. Millions of our members are using our digital virtual assistant and benefiting from proactive member engagement. For a subset of care providers connected to us via our interoperability platform Health OS, we have cut prior authorization bounce backs for insufficient information by approximately 60 percent for inpatient concurrent reviews. I want that percentage to continue to increase.

We are working with a lot of the provider ecosystem to build more seamless interoperability in getting the right information at the right time for faster decisions. We are evolving internally to continue providing simplification for our members and providers. As we move more toward self-service, every member should be able to get what they need, 24/7.

Looking forward, we will continue with our three core tenets: stay focused on simplifying the experience, personalize that simplification and really guide care journeys in the moments that matter.

This report has been paid for by a third party. The views and opinions expressed are not those of Newsweek and are not an endorsement of the products, services or persons mentioned.