Health plans are facing a pivotal shift in their day-to-day operations and member engagement. Artificial intelligence (AI) is no longer just an emerging technology — it’s a strategic necessity.
Integrating AI into payer operations isn't just about automation. It's about enabling smarter decision-making, improving health outcomes and delivering better experiences for members. With budget pressure and the growing need to operate more efficiently, the question is not if insurers should adopt AI, but how to do so most effectively.
The complex relationship between AI and healthcare
“AI’s potential in healthcare is exciting, but realizing that potiential requires thoughtful execution,” says Ryan Paligo, Chief Technology Officer at Healthmine. “Payers operate in an environment where technology must meet the highest standards for accuracy, security and regulatory compliance. That means solutions must be practical, proven and aligned with existing workflows, not just disruptive for the sake of innovation.”
That’s why Healthmine’s strategy is different. We’re not implementing AI just to say we do it. We’re building a purpose-driven platform and meaningful member experiences, enhanced by AI only when it makes sense, when it adds clear ROI and when it solves real-life barriers.
See how we’re using AI to increase provider visits and gap closure with hands-off appointment scheduling for members.
Our team has been working with and inside health plans running government programs for decades, many of them since the inception of Medicare’s Star Ratings program. We are intimately familiar with the considerations health plans have related to security and compliance that most other industries don’t. Any AI tool must adhere to strict regulatory standards that protect patient privacy, data and safety, and prevent bias or discrimination.
As for members, plans need to ensure AI doesn’t disrupt the patient experience. Poorly administered or implemented AI systems can erode member trust, create deep dissatisfaction and have substantial impacts on member retention.
“You have to proceed with caution — but you do have to proceed. Sitting still means falling behind. The right approach is to identify use cases where AI already meets the bar for security, compliance and performance, and start there. That’s where you’ll see real, low-risk returns.”
Healthmine’s AI strategy
Our AI strategy is focused on delivering measurable ROI to health plans by driving efficiency, reducing costs and improving member outcomes. By streamlining operational workflows and automating routine tasks, we eliminate workforce burdens — freeing teams to focus on higher-value, member-centric activities that require critical thinking and problem solving.
“AI excels in areas where human input doesn’t significantly add value — especially repetitive tasks that are expensive to scale. For example, appointment scheduling is critical, but it’s not strategic. It doesn’t require empathy or clinical judgment — just efficiency. That’s exactly the kind of job AI can take off a plan’s plate.”
In short, our approach is to enhance what humans can already do well. When building patient scheduling into our Quality Relationship Management™ (QRM®) platform, we were focused on creating the most impact in six ways:
- Fewer touchpoints for the member during scheduling to minimize appointment resistance.
- Ease of appointment creation, allowing members to request and confirm appointments on the same day without disrupting their daily life.
- Flexibility to connect with an established doctor, or to find a new provider with or without specific criteria to elevate trust between members and their doctors.
- Appointment preparation, increasing the likelihood the member completes a comprehensive visit.
- Follow-up care based on the member’s individual health risks to encourage continuity of care and reduced costs associated with emergency care.
- Dynamic reporting for plan operators to monitor progress towards gap closure and optimize rewards budgets.
Explore our online mini demo to see how easy and intuitive AI-driven appointment scheduling is.
Patient scheduling is just the beginning of us integrating AI to enhance the day-to-day operations of our plan partners. And while many point solution vendors have been touting AI advancements already, we’re less focused on chasing a trend than we are on chasing high-value enhancements that create meaningful impact with measurable ROI. Let us tell you more — schedule a call with our team.
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