The Role of AI in Improving Healthcare Communications
By John Zimmerer, VP of Healthcare Marketing at Smart Communications
I’ve previously written about the need to use plain language in healthcare communications. According to a recent Forrester report, the need not only still exists, but the urgency to address that need is now greater than ever.
In Health Insurers: Communicate Clearly To Help Your Customers Decide With Confidence (Forrester Research Inc., February 24, 2025), the authors provide compelling evidence that poor communication is harming health insurers and their members. In this post, I will present snippets of that evidence, as well as the role AI can now play in improving healthcare communications.
Interested in learning more about using AI to analyze and improve your content?
Check this demo out later!
Members Do Not Understand Their Plans or Your Healthcare Communications
As part of their ongoing research into customer experience, Forrester regularly surveys consumers about their experiences with a variety of organizations, including healthcare insurers. Their most recent survey data shows that “only half of US online adults who are health insurance customers say it’s easy for them to understand their coverage.”
Forrester’s data also shows that the number has been dropping over the last two years. Contrast that with what the Kaiser Family Foundation (KFF) reported: at least 90% of insured US adults want clearer communications from insurers, with a focus on what’s covered and how much they’ll have to pay.
The Forrester report linked the lack of understanding to four economic impacts:
-
Revenue Risk: The authors contend that members who do not understand their coverage may have a reduced feeling of the value of that coverage. They warn that “customers may conclude that they aren’t getting the best value and choose a lower-cost offering that falls short on coverage needs.” I will go one step further: These members may very well switch carriers. At the very least, payers will see less revenue if members downgrade plans.
-
Higher Expenses: Forrester’s data shows that members who do not understand their benefits pick up the phone and call their insurer. The report cites benefit inquiries as the top driver of calls. KFF found that confusion about coverage and responsible portion also drives a significant number of appeals, the majority of which are ultimately decided in the member’s favor.
-
Product Differentiation: The authors point out that members who can choose their plans (e.g., ACA and Medicare Advantage members) may find it difficult to choose a plan if they do not understand the benefits included in the myriads of offerings available to them.
-
Trust Erosion: The Forrester report points out that “communicating clearly is a great way to demonstrate empathy, a key driver of trust.” That is important because trust correlates with the propensity to spend money…or not.
Member Expectations and How to Communicate More Clearly
The report goes on to define key moments that matter to members, including shopping for and enrolling in a plan, onboarding, and servicing. The authors specifically call out explanations of benefits and claims communications as moments where plain language matters. The report includes a graphic showing key customer experience drivers, and how health insurer ratings on every one of these drivers fell from 2023 to 2024. Of the five key drivers measured by Forrester, “Communicates with me using plain language” fell the most.
Thankfully, the authors provide clear recommendations on how to remedy the situation. You’ll need to read the report to get the details, but I will summarize them as:
-
Mine Your Data: Your customers are speaking to you. Are you listening to them? Every engagement you have with a member provides insights into their pain points and what you could do to improve their experience. Forrester provides clear questions in the report that you should use to interrogate your data (e.g., call recordings, surveys).
-
Revise Your Content: The authors point to multiple resources and provide examples to help you improve the clarity of your communications. Yes, some communications have content that regulations require you to use verbatim. However, the report suggests ways that you can balance the spirit of plain language with the literal letter of the law.
-
Mind Accessibility: There are already regulations that require you to produce communications in accessible formats. The report offers creative ways that you can use accessibility to promote communicating more clearly with a broad audience.
-
Assess Your Approach: The authors recommend an approach to cocreating or iterating your content with your members. This approach will require you to make an investment; however, that investment will pay dividends in reflected calls and reduced appeal volume.
-
Best Practices: Lastly, the authors provide guidance on how to institutionalize what you learn into an enterprise-wide approach to communicating using plain language.
The Role of AI in Communicating Using Plain Language
With proper governance, artificial intelligence (AI) can play a key role in communicating using plain language. AI can help you evaluate your content for readability, tone, and sentiment. It can help you to revise content, reducing the use of jargon and distilling legalese into more relatable (and often more concise) language. It can find and help you to address accessibility issues. And now, with agentic AI, it can even mine your data and provide insights into ways to improve your member experience.
This might sound like science fiction or may even be a bit scary. But tools exist today that can help you do your job faster with better outcomes for you and your members.
Here are three examples of what AI can do to help you to communicate in plain language:
-
Content Analysis: As we learned, clarity communicates empathy, which engenders trust. So, you’ll want to use AI-based content analysis tools that can evaluate your tone, sentiment, and readability. The best content analysis tools combine neurolinguistic processing (NLP) with machine learning (ML) and reference standards like the Flesch scale to score your current content and create a baseline.
-
Writing Assistance: Once you have that baseline, you can use generative AI (GenAI) tools to revise your content to improve your scores. You simply provide instructions (also known as prompts) on what changes you'd like to see, and prompt using plain language. You might use the tool to revise the content to increase empathy, or to hit a target reading level score. Then, GenAI goes to work and provides revised content that you can reanalyze and rescore.
-
Accessibility Tools: A combination of AI tools can look at your content and tell you where you are not meeting accessibility guidelines like WCAG 2.1. Maybe the contrast ratio of text on a background color is too low. Or you forgot to tag an image with alternate text. The AI can find these flubs and then guide you in remediating your communication. AI tools can also provide initial language translations for review and approval by a certified human translator.
Smart Communications Can Help You Communicate Using Plain Language
Are you excited by the possibilities? Then you are ready to switch to a customer communication management (CCM) solution that uses AI to help you communicate in plain language. Our CCM platform, called SmartCOMM™, has built-in AI tools including content analysis, a writing assistant, and an accessibility checker. We also have pre-built integrations for agentic AI platforms that can use our data and other sources to deliver powerful, actionable insights for increasing the effectiveness of the content you manage in SmartCOMM.
If you’re looking to improve member experience, operational efficiency, or revenue, consider using SmartCOMM and its built-in AI tools and integrations. By adopting our CCM solution, you can increase member trust, satisfaction, and loyalty while also improving your bottom line.
Ready to get started?
Request a demo of SmartCOMM to discover how it can help your organization supercharge its customer communications and create an exceptional customer experience.
About the Author
John Zimmerer is the Vice President of Vertical Marketing, Healthcare at Smart Communications, where he acts as a subject matter expert on the digital transformation of customer communications and data-centric, often form-based workflows. Most recently, John has been researching and writing about improving customer experience in healthcare and is regarded as a thought leader in this area. John has over 20 years of software product marketing experience. His areas of expertise include market research, analyst relations, public relations, and digital marketing.