Conversational AI

AI Tools Can Improve Every Step of the Member Journey

November 29, 2022

AI Tools Can Improve Every Step of the Member Journey

For many health plan members, health journeys are filled with obstacles. Members may face exorbitant wait times, confusion about where to go or whom to contact, difficulty scheduling appointments, and complex member portals that are difficult to navigate.

However, artificial intelligence (AI) tools can revolutionize the member journey and boost engagement at every step along the way. Here’s how AI tools can make a difference at various stages in a member’s journey with their health plan:


During the onboarding process, an AI-powered assistant can answer the member’s questions about their coverage or guide the member to search directly for in-network care options. The assistant can also engage the member to conduct health risk assessments and to update their member profile.

Care delivery

When a member needs healthcare, they can converse with the health plan’s AI assistant about their symptoms through the health plan user portal. With machine learning technology, the assistant can guide the member to the most appropriate level of in-network care based on their symptoms. A member can also use the assistant to complete tasks such as booking appointments and viewing provider information. The most robust AI tools can also proactively engage the patient to complete pre- or post-care questionnaires.

Gap closure

Scheduling appointments and seeing new providers often results in member frustration, as they may have to log into various portals or complete redundant forms. The right AI tool can simplify that process, completing the full appointment scheduling and paperwork process through an in-portal chat. There’s no need for multiple pages, redundant forms or complicated processes, so members are more likely to immediately book the care they need.

In addition, AI-driven tools can close gaps in care by reaching out to members periodically with preventive campaigns tailored to their health profiles, or as dictated by the health plan.


An AI-powered assistant can also help health plans boost enrollment rates by streamlining communications to members and simplifying the process of enrollment. Additionally, these tools can conduct satisfaction surveys to identify areas for improvement. Perhaps most important, the right AI assistant will help the member feel confident in their own abilities and comfortable in their health plan.

Fabric's Digital Front Door® solution uses a robust, AI-powered assistant to engage with health plan members at the right time to create an intuitive and seamless experience throughout their health journeys.


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