• Scalable personalization: AI ensures every interaction, regardless of channel, is informed by prior data, promoting member confidence and satisfaction.
According to the International Journal of Information Management, “AI-enabled CRM capabilities increase customer experience quality, enhance adaptability to market conditions, and foster service innovation,” positioning health plans to excel in competitive markets.
Human-AI collaboration: The best of both worlds
Despite AI's advanced capabilities, some interactions require the empathy and nuance of human agents. For example, discussions around sensitive medical issues or complex care coordination benefit from the compassion that only a human can provide. AI augments these interactions by:
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• Handling routine tasks and inquiries, freeing human agents to focus on high-value, empathetic interactions.
• Providing decision support, offering human agents insights and recommendations that enhance member outcomes.
This synergy between AI and human agents drives higher Net Promoter Scores (NPS), improved Star Ratings, and greater member retention. As noted in JMIR Cancer, “Human elements in health care will not be replaceable...but chatbots and AI systems can refine workflows, reduce costs, and improve outcomes.”
Why health plans must act now
Health plans that embrace AI today position themselves as leaders in the industry, gaining a competitive edge through:
• Cost Efficiency: Reducing administrative burden and optimizing resource use.
• Member Satisfaction: Delivering personalized, proactive support that meets and exceeds expectations.
• Improved Health Outcomes: Using predictive analytics to intervene early and effectively.
AI is no longer an emerging technology; it’s the inflection point for health plans to redefine what’s possible. By investing in AI responsibly, health plan executives can achieve operational excellence, meet member expectations, and ultimately drive better health outcomes.
The future of health plans isn’t about keeping pace—it’s about setting the standard. AI is the tool that will take your organization there.
About the author: Rob Adhikari is the vice president of sales at Sagility, where he partners with health plans to deliver innovative solutions that transform operations, improve member experiences, and enhance health outcomes.
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