Intelligent Healthcare Platform

The Intelligent Healthcare Platform is an adaptive listening and response solution for associates to better support member/patient/customer inquiries related to their health plan information with targeted outcomes such as reducing call handling times, helping summarize and explain complex policies and documents, providing real-time coaching and next best actions which can help reduce training time for the associates, and lastly, provide automated responses (both in unstructured and structured format) to the associate based on the real-time conversation. Some other core capabilities consist of React native and Deepgram enabled voice-to-text services to power a real-time conversation transcript. The platform has integrated scoring and SHIELD (Safety and Health Integrity Evaluation for LLM Detection) services which consists of live and offline LLM supervisors that help monitor and evaluate bias, toxicity, counterfactual analysis, and hallucinations The platform also includes post call summarization and feedback loop capabilities to provide outputs and continuous improvements.

Domain Agents (Benefits, Contract, Scheduling, Billing, Clinical, etc.):

Provides detailed information about available health plans, coverage options, and plan features to assist associates and members in making informed decisions. Explains specific member benefits, coverage limits, and eligibility criteria, helping associates address complex benefit-related inquiries efficiently. Manages and retrieves contract details between payers, providers, and members, providing accurate information for service and compliance needs. Assists with scheduling appointments, follow-ups, and reminders for patients, coordinating with providers and internal systems. Addresses billing questions, clarifies charges, and assists with payment processing and issue resolution for both patients and associates. Supports clinical decision-making by providing evidence-based guidelines, care recommendations, and clinical documentation assistance to healthcare professionals.

Common Service Agents (Coaching, Summary, Text to SQL, etc.):

Delivers real-time guidance, feedback, and leading practices to help healthcare associates improve service quality and compliance. Automatically generates concise, accurate summaries of member interactions, cases, or medical records to streamline documentation and handoffs. Converts natural language queries from associates into SQL statements to retrieve relevant data and visualizations from healthcare databases quickly and accurately.

Potential Benefits:

Reduce Average Call Handle Time: Streamline resolution processes to lower call duration by an estimated 40%.

Increase First Call Resolution (FCR): Enhance accuracy and responsiveness for more issues resolved on the first interaction.

Boost Net Promoter Score (NPS): Improve customer satisfaction and loyalty through better support experiences.

Reduce Associate Training Time: Accelerate onboarding and upskilling, cutting training requirements by an estimated 50%.

Increase Calls per Associate: Enable staff to manage higher call volumes efficiently.

Reduce Associate Attrition: Lower burnout and turnover with AI-supported assistance, decreasing attrition by an estimated 20%.

Increase Calls per Staff Hour: Improve productivity and resource utilization, allowing more calls to be handled in less time.

This is a professional services engagement to configure and deploy these agent(s) using AWS Generative AI services