Using “Rachel,” an AI Care Specialist, to Connect with Health Plan Members

Welcome to “Objectives in Action,” our on-going series that features teams from across the organization that are working to make our Top Company Objectives a reality.

Top Company Objectives:

• Lead New York State in Integrated Long-Term Care (MAP) and
• Bring our operating margins and cost structure in line with the rest of the industry. 

Teams: Health Plans (including the Health Plans Business Implementation Team, Member Experience, and Member Retention), Care Management, CCSS, Compliance/Legal, IT (including IT Data Architecture Services), Provider Operations, and Provider Relations.

The situation: Last fall, our Health Plans team enrolled around 10,000 new members in our stand-alone Medicare Advantage (MA) health plans—Easy Care and EasyCare Plus. While the annual enrollment period was extremely successful, to get this record number of new members on-boarded quickly was a challenge. That’s because the health risk assessment process—a key part of on-boarding, which ensures the member gets the right level of care—requires a real-time phone interview, and these MA members can be hard to reach.

Zoom in: Because EasyCare and EasyCare Plus members are quite active and are often out and about in the community for much of the day, connecting with them by phone to schedule their initial health risk assessments can be difficult. As a result, Health Plan team members have been investing large amounts of time trying to reach these MA plan members.

Top Company Objective in Action: To connect with hard-to-reach MA plan members in a more efficient and effective way, the Health Plans team teamed up with Hippocratic AI, a health-tech company that uses artificial intelligence (AI) to improve healthcare safety and accessibility. Working with Hippocratic AI, the Health Plan team used an artificial AI care specialist to talk on the phone and conduct the survey with newly signed-up EasyCare and EasyCare Plus members.   

Using a script that was developed by the Health Plans and Care Management teams, the AI care specialist, named “Rachel,” began phoning EasyCare and EasyCare Plus members at times that were convenient to them. “Since the calls are all computerized, ‘Rachel’ can phone our members repeatedly, including after hours—she never gets tired—and do this for thousands of members at the same time,” explains Aman Shah, Vice President, New Ventures and Strategic Partnerships.

Once “Rachel” connects with a member, she then goes through the health risk assessment checklist with the member over the phone.

To make sure each AI-generated call goes smoothly, the Health Plans and Care Management teams did extensive internal testingto refine the programmed scripts that guided “Rachel’s” conversations. “We started by having people from our team do test conversations posing as plan members,” says Amanda Zaragoza, Manager, Health Plans Operations. “Once we felt the script is in a pretty good place, we then tested it further with a small cohort of actual plan members and made any additional changes that are needed.”

Results:  Since Health Plans began using “Rachel” earlier this year, the bot has successfully completed nearly 1,900 health risk assessments in either English or Spanish.

Why it matters:  Using Hippocratic AI’s language model to automate our many outbound calls frees up our teams to operate at the top of their license. It also streamlines our operations and enhances the member experience by enabling us to touch our members more frequently.

“With the addition of this AI capability, our plan members are getting onboarded faster and there’s less strain on our own team members, so it’s a win all around,” notes Aman. “Plus, the AI tool provides a good member experience. ‘Rachel’s’ script includes personal, empathetic touches, like asking about the member’s family. And she remembers everything a member told her in prior calls.”

Since health risk assessments must be done yearly for each plan member, Hippocratic AI will continue be used for annual assessments of EasyCare and EasyCare Plus members going forward, in addition to their initial assessments. (Plans also call for extending this service to members of VNS Health Total, our integrated MAP plan, in the near future.)

These bot-driven assessments are just one of the ways that VNS Health is partnering with Hippocratic AI to enhance member engagement, provider data accuracy, and measures adherence through AI-driven automation.

What’s next:  Besides being fluent in English and Spanish, by mid-2025 “Rachel” will be able to do outreach and conduct assessments in Mandarin as well. “We’re also working now to tweak her accent and get her to speak a little faster, to fit better with the way typical New Yorkers talk,” says Amanda. 

Driving Toward Our 3-year Strategic Goals: This Objective in Action will help us reach our goal of having 100,000 patients, members and clients in our care on any given day. (Our Health Plans alone now have almost 75,000 members.) Because it improves the member experience, it’ll also help us reach our 5-Star Quality and Consumer Experience goal.

Want to hear what “Rachel” sounds like? Click here to listen in on a mock call!