Covered California Modernizes Enrollment Process With Google AI Tool

Covered California, the state’s health insurance marketplace, is expanding its technology repertoire to improve accessibility and efficiency in connecting residents with health-care options. And it seems all roads lead back to the day’s trending topic: artificial intelligence.

The organization announced last week that it will officially implement Google Cloud‘s AI solution, Document AI, in June to automate parts of its documentation and verification process when residents apply for coverage. This AI-powered solution uses machine learning to automate the repetitive task of verifying resident information. Once the solution is live, residents will be able to securely upload their documents through Covered California’s online application to receive instant verification status.

Covered California’s journey to the Google AI partnership began roughly 12 months ago when officials recognized a need to optimize the lengthy application process and wait times for electronically submitted documents that verified residency and income eligibility.

According to a recent press release, some 6.5 percent of California residents lacked access to basic health insurance in 2022. Brent Mitchell, vice president of U.S. State and Local Government and Education for Google Public Sector, told Industry Insider that number identified a need for expedited services and uncovered an opportunity for modernization.

“A time-consuming and relatively manual part of Covered California’s journey to connect residents with health-care options includes completing paperwork to determine eligibility, and it can take weeks to determine that someone has accidentally submitted the wrong form in some cases or input inaccurate information,” Mitchell explained. “Even if this doesn't cause a direct lag in coverage, it does create additional work for Covered California staff and consumers to find and submit updated eligibility determination documentation.”

Teaming up with Google and utilizing Deloitte’s technical architects and engineers for system integration, Covered California embarked on a proof of concept to test the viability of Document AI in their systems, monitoring document acceptance during a period of time. The initial results proved successful, with Covered California achieving a document verification rate of 80-96 percent — depending on the document type — for an average of 84 percent acceptance. The previous solution had a document review completion rate of only 18-20 percent.

In order to ensure privacy and security, Covered California is also using Google Cloud’s Assured Workloads to manage and maintain FedRAMP compliance and Google Security Operations to help eliminate security blind spots and safeguard against attacks.

Karen Johnson, chief deputy executive officer at Covered California, explained that the adoption of this new technology is just the beginning of ongoing endeavors to remove complications and barriers to health-care accessibility.

“This is going to be a game-changer for our consumers and employees,” Johnson said. “Residents will be able to receive real-time acceptance and be able to get feedback from our teams faster. In addition, this new system will propel us even further towards bringing additional AI tools into our environment, boosting broader acceptance and adoptions from our consumers and our employees.”

Mitchell shared similar sentiments regarding future collaborations between Google and Covered California.

“There is enormous potential for AI to transform the public sector,” he said. “Whether it’s predictive analytics, virtual assistants, or multilingual online portals, we will continue to work with Covered California to explore ways for the organization to enhance services for their customers using our data analytics and AI solutions.”

Johnson said Covered California is taking a slow and steady approach towards AI to make sure that anything it supports with AI is the right fit for the organization.

“We’ve done a couple of things with our transformational journey with AI, but it’s really been about educating, learning from our private-sector partners, doing proof of concepts, and then working through what the next use case will be based on what we’ve learned,” she said.

Looking ahead, Johnson shared that Covered California plans to continue its innovative path toward introducing new technologies to enhance the enrollment experience and improve health-care accessibility for residents.

The organization is currently exploring the potential usage of a large language model that would centralize all of its policies and procedures so that employees don’t have to spend a significant amount of time searching for internal information.

“We operate as a nimble and flexible organization, encouraging creative solutions that push boundaries, overcome constraints, and drive progress,” Johnson said. “Our commitment to people, teamwork, integrity, innovation and accountability drives us to continually prioritize learning, experimentation, and growth to enhance experiences for our residents and employees.”