3 Exciting AI Solutions That Will Help Us Grow Our Health Plans
INSIDE HEALTH PLANS with John Burke
Believe it or not, we’re more than midway through 2025. I’m really excited about how our Health Plans are continuing to grow this year. We now have over 60,000 members in our five health plans, up from 50,000 just a year ago. We’re also in over 35 counties across New York State. We’re laser-focused on maintaining this growth, and one of the key ways we’ll be doing that is with artificial intelligence (AI).
Here are three AI solutions that our Health Plan team is either using now or exploring. In each case, these AI solutions are aimed at helping us operate more efficiently so we can set the stage for future growth, while also freeing up our team members to focus on providing the best possible care to our members.
Streamlining our enrollment and utilization management processes
We’re using AI to transform the way our MLTC plan enrolls members, authorizes services, and manages billing, through the deployment of three innovative applications. By introducing advanced automation and intelligent workflows that speed up enrollment, our goal is to significantly improve member conversion rates. This initiative will also enable us to grow more efficiently, by eliminating manual processes and disconnected systems.
Handling easy-to-answer phone inquiries
As our Health Plan enrollments grow, inbound phone calls from plan members who have questions about their benefits are increasing. To help us answer them—and at the same time provide an excellent member experience—we’re looking into AI solutions for handling phone calls involving easy-to-resolve issues. This will free up our team members to concentrate on the more difficult issues members are calling about.
For example, many of our Medicare members call us to check the remaining balance on their OTC cards that they use to purchase over-the-counter pharmacy items. We’re using an AI care specialist, whom we’ve named Lily (after our founder Lillian Wald), to automatically provide those members with their updated card balances. Lily can also supply members with other helpful information, including a list of pharmacies and other retailers where they can use their OTC cards.
Providing extra, personalized support to our most vulnerable Health Plan members
We’re also looking at other possibilities, such as how we might use AI to help us monitor our claims data and alert us when a Health Plan member is having issues—when they fail to pick up a prescription medication, for example. In this scenario, AI might be programmed to automatically reach out to that member and have a conversation with them to find out why the prescription wasn’t filled. One great capability of AI is that it can call thousands of members at the same time, as well as call back as many times as necessary until the plan member answers. Once AI has connected with the member and identified what the problem is, one of our care managers would then follow up and speak with the member as needed to resolve the issue.
These are just a few of the ways AI is helping us—or will be helping us—to enhance our member experience, which in turn will enable us to grow while also providing the best possible care to our members. To my thinking, that’s an AI recipe for success!
