Conversational AI

AI-Driven Tools Drive ROI for Health Plans

December 6, 2022

AI-Driven Tools Drive ROI for Health Plans

Traditionally, health plan members interact with their health insurance provider as little as possible. That’s because interactions with the health plan usually aren’t easy—they require long wait times on the phone, completing clunky forms, or figuring out how to use online portals that are rarely intuitive.

However, when members engage with their health plans, that often translates into improved health and financial outcomes. For example, the health plan can remind the member about important preventive screenings and care, make sure the member selects in-network providers for appointments, and help them understand their financial obligations before choosing a provider.

Clearly, health plans need better engagement with members to improve their bottom lines and their members’ health journeys. And today’s technology makes it possible for health plans to drive interactions that will not only meet members’ needs but also keep them coming back when they require further care.

How Technology Drives Engagement

Rather than leaving members alone to navigate their own experience with their health plan’s member portal, phone queue and thick manual of plan guidelines, technology makes it possible to provide members with a personalized assistant. Using artificial intelligence (AI) and machine learning, a tech-powered assistant can answer members’ questions, triage members’ symptoms, recommend providers, and send reminders and follow-ups regarding care.

For example, Fabric offers a member journey system powered by artificial intelligence that has been shown to improve the experience and drive engagement for health plan members. At each step of a member’s journey, the AI-enabled assistant guides the member through enrollment, onboarding, care delivery, managing gaps in care, and ongoing communications. Members are no longer left to their own devices to figure out their health coverage—and, as a result, they become more engaged with their health plans and their healthcare.

When health plan members have access to automated, intelligent engagement systems, they gain confidence in their ability to manage their own healthcare. As their confidence increases, member behavior and health trend in a positive direction.

AI-Powered Engagement Demonstrates ROI

Health plans that have started providing intuitive, AI-enabled journeys for members are already seeing a return on their investment. Fabric's early figures show that members have received the AI assistants well and continuously use the services.

Customers who have implemented Fabric have seen:

  • An increase in members accessing their member portals. About 40% of users return to Fabric twice or more in a six-month period.
  • An increase in health plans’ ability to make contact with members. Health plans using Fabric report a 50% increase in contact rates for outreach programs.
  • A drop in members calling their health plans for information. Health plans using Fabric report a 30% decrease in call volume in their contact centers.

Fabric's digital front door solution is built to engage with health plan members at the right time to create an intuitive and seamless experience.


Asynchronous Care

Asynchronous Telemedicine Guide + COVID-19: The Largest Case Study on Async

When we built this guide, we set out to create a single comprehensive resource for everything healthcare professionals will ever need to know about asynchronous telemedicine. It’s 29 pages of pure data, research, and the largest case study ever conducted on async. 

Case Study

Gain capacity to care

Maximize clinical capacity, reduce administrative burden, expand access, and increase patient satisfaction.