Conversational AI

AI Tools Can Help Members Better Engage With Health Plans

November 22, 2022

AI Tools Can Help Members Better Engage With Health Plans

Most health plan members interact with their insurance provider as little as possible. The relationship between the plan and its members is impersonal and distant, which leads to poor engagement. However, the right artificial intelligence (AI) tool can overhaul the member experience, boosting engagement and member satisfaction.

Why Members Aren’t Engaged

Most health plans don’t provide members with a personal walk-through or a clear onboarding process, so members are on their own to manage their health in a system that is complicated and expensive. They face a number of obstacles in managing their healthcare, including:

  • Complex user portals
  • Difficulty finding needed information
  • Long wait times for phone service
  • Confusion about where to go or whom to contact
  • Scheduling difficulties
  • Questions about costs and payment for healthcare
  • Confusion about how to manage chronic issues and medication

For all these reasons, many members become frustrated when they try to interact with their health plan. That frustration sticks with them and deters them from future engagements, and it also drives up costs and challenges for payers. For example, health plans may have to deploy extra staff to bridge the gaps in member knowledge; they also risk member leakage and face potentially negative ratings.

How Technology Can Transform the Relationship

The current experience for most health plan members may be chaotic, confusing and ineffective. But the right technology can transform a member’s experience with their health plan into one that is frictionless and intuitive, providing them with care and answers. By using technology to give members an easy, satisfactory experience, health plans can build member confidence and establish relationships that lead to sustained engagement.

AI tools can create intuitive member journeys that take members through the natural touchpoints of acquiring care, receiving care and interacting with their plan. For example, AI can help triage members’ symptoms; suggest appropriate providers; schedule appointments; and send reminders about medications, appointments or other healthcare needs.

Health plans can transform their members’ experience by deploying AI tools that provide:

  • Simple user interfaces
  • Integration with the health plan’s website, member portal or mobile app
  • Seamless transitions
  • Proactive guidance for onboarding, care delivery, gap closure and loyalty

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. Fabric provides a digital front door solution that engages with health plan members at the right time to create an intuitive and seamless experience.


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