Advancing Care with Intelligent Next-Gen Technology
This article is the second of a four-part series describing how the four business process management (BPM) pillars can optimize operations.
By Madan Moudgal, Executive Vice President, Chief Digital Officer
As healthcare organizations face mounting pressure to improve outcomes, reduce costs, and enhance experiences, the intelligent application of next-generation technologies has become a strategic necessity. From AI-powered contact centers to predictive analytics and GenAI voice agents, these innovations are transforming how organizations deliver and manage care. But technology alone isn’t enough; moving the needle comes from pairing these tools with deep operational expertise. Embedding human intelligence into every layer of the healthcare value chain ensures that automation not only streamlines tasks but also drives smarter human decisions, faster resolutions, and better care coordination.
Advanced data analytics plays a critical role in enhancing the transfer of AI to human intelligence. By surfacing actionable insights — like identifying common points of failure in claims or predicting high-risk patient behaviors — organizations can reduce redundant transactions and support more informed decision-making. The result is less friction across the system and greater operational agility.
Operational, Business Benefits for Payer-to-Payer Interactions
A GenAI voice agent supports payer-to-member communication; it can do the same for payer-to-payer communication in several important ways. Confirming member coverage is a time-consuming, arduous task. With the assistance of a GenAI voice agent, however, health plans can shift much of this work to this emerging, powerful technology. Because the GenAI agent can make outbound calls to other payer organizations to verify a member’s coverage, the technology coordinates benefits between payers.
In addition, a GenAI voice agent supports efficient claims processing through the automation of routine tasks like claims verification, eligibility checks, and prior authorization requests. This automation reduces processing time, mitigates errors, and improves operational efficiency, which reduces expenses and leads to significant cost savings.
Enhancing Stakeholder Relationships
GenAI voice agents actually build and maintain relationships among payers, providers, and members. The reason? This technology ensures that member information is captured correctly and acted upon by health plan experts: care coordinators, caregivers, and providers. In addition, GenAI voice agents free up staff for more strategic activities within the business.
Healthcare operations also demand intelligence that can learn, adapt, and actively enhance how work is done. Agentic AI does not just offload repetitive tasks, but augments process design, elevates productivity, and enables proactive decision-making across the patient care lifecycle. Agentic AI agents act with autonomy and purpose, guiding interactions, surfacing recommendations, and refining processes in real time, reducing variability and delivering superior and consistent outcomes in cost, quality, and member experiences.
How Hybrid Intelligence Empowers Care
Imagine that a physician submits a request for a non-standard treatment. Agentic AI can verify whether the procedure is approved or denied. If denied and the patient challenges the denial, the agent can automatically follow up to gather documentation and identify potential solutions. If the challenge requires more complex medical expertise, the agent can escalate the case to a human reviewer. This process blends intelligence, reduces delays, and gets patients the care they need faster.
When organizations integrate technology intelligently with human expertise, their ability to strengthen their operations increases, their ability to be more cost competitive improves, and their likelihood that they will overcome the range of challenges facing this industry advances dramatically.
The Future is Intelligent Care
The future of healthcare lies in intelligent, adaptive systems that do more than automate — they learn, evolve, and optimize. The approach to GenAI and Agentic AI can empower healthcare organizations to reduce friction, enhance collaboration, and deliver measurable improvements in cost, quality, and satisfaction. By aligning the right technology with the right processes at the right time, organizations can move beyond efficiency toward excellence. In a rapidly changing industry, hybrid intelligence is not just a competitive advantage — it’s a catalyst for transformation.
Read more in our white paper, Fixing the Friction: How Strategic Operations Management Unlocks Healthcare Efficiency at Scale, to explore how the four BPM pillars can reduce operational burden, improve patient outcomes, and drive resilience across the care continuum.