The idea of helping health plans increase member enrollment in health risk adjustment programs that improve health outcomes, care coordination, and quality of life is nothing new.
Health plan executives today face unprecedented challenges: the need to reduce costs, improve operational efficiency, compete in an evolving marketplace, and deliver exceptional member experiences. Artificial intelligence (AI) offers a transformative opportunity to achieve these goals. Leveraging AI isn't just a trend—it's a strategic imperative for health plans seeking to remain competitive and member-focused in a rapidly changing landscape.
As use cases for and the acceptance of GenAI continue to grow, health plans have a unique opportunity to not only push the envelope but rip it wide open. The next step in the evolution of conversational AI is GenAI voice agents. These agents engage in fluid and natural conversations and better understand nuances in human language. This leads to more accurate and contextually appropriate responses. Importantly, they can generate more human-like speech with variations in tone, intonation, and emphasis, making interactions more engaging.
Sagility aims to accelerate growth in the mid-market payer segment with this acquisition
Protecting member and patient data is a critical concern for all healthcare organizations. Members and patients expect health information to remain private. Sagility's Don Searing, Vice President of Product & Engineering, and Alan Vitale, Vice President of Technology & Transformation Management, discuss how healthcare organizations can take specific steps to protect that data through IT security best practices for Security magazine.
With ever-increasing pressure on profitability and medical loss ratios, healthcare payers face tight budgets, a continued need to increase productivity, lower costs, enhance technology, and reinforce IT infrastructure while improving the healthcare consumer experience. Get tips on how payers can develop new strategies to improve operational outcomes from Sivarama Rambhatla, Sagility’s Senior Vice President & Global Head of Solutions, in this article in HealthCareBusiness News.
The healthcare industry is constantly evolving and health plans, in particular, face many challenges ranging from regulatory changes to rising operational costs. In this changing landscape, health plans may not have a clear vision of the course needed to successfully navigate the continuous evolution of the healthcare system. Read this article in In Healthcare Business Today written by Rajaram Natarajan, Senior Vice President of Client Services at Sagility, and learn how a BPaaS model can clear the way to success.
The healthcare contact center landscape is undergoing a revolution, driven by rapid advancements in artificial intelligence (AI). These technologies are reshaping how interactions are managed and enabling more efficient workflows, personalized experiences, and proactive solutions. In 2025, this technology will push the creation of tangible business outcomes, improvement of the customer experience, and the building of efficiencies. Learn more from Abhishek Danturti Sharma, Associate Vice President, Business Transformation at Sagility.
Would you contribute your medical records to an organization dedicated to improving healthcare worldwide if the data were anonymized and used for the “greater good”? To benefit humanity? Generative AI models could be made more effective with larger healthcare information datasets. Individuals could consider contributing their healthcare data for such purposes if assurances are provided that data would not be misused. A well-managed organization committed to improving the health and wellness of the underserved worldwide could benefit from the data by informing generative AI designed to assist treatment in underserved communities. So, should we consider sharing our healthcare data for the greater good? In this article by Madan Moudgal, Head of Technology Solutions, he lays out the pros and cons of sharing medical information.
The contact center has a front row seat to generative AI (GenAI) in the workplace. Traditionally seen as cost centers focused on customer service, contact centers are now poised to become innovation hubs. This AI-driven transformation is not just automating routine tasks but also creating new roles, augmenting existing ones, and reskilling agents for future-ready positions. In Healthcare Business Today Sagility’s Abhishek Danturti Sharma, AVP Business Transformation, and Rob Adhikari, Vice President of Sales, share new insights with “Transforming Contact Centers into Innovation Hubs: The Role of AI in Creating New Opportunities.”
There are significant opportunities all along the payer points of service. Payment integrity (PI), as a touchpoint central to claims adjudication, reimbursement, and value-based care delivery, is ideally suited to the enhanced accuracy, savings, and speed to pay. But it’s not technology in isolation that will solve for the complexities of this point of service. Read “Achieving Payment Integrity Precision in the Age of AI,” in HealthCare Business News by Subrahmanyam Mantha, Vice President, Payment Integrity Practice, Sagility.
From front and back office to clinical, operational excellence that connects points of service is more important than ever. All along the member/patient journey, tech enablement creates new opportunities to bridge gaps. In this Forbes Business Development Council article by Sagility’s Chief Growth Officer Sohail Djariri, read insights into how healthcare services partners can help to provide better efficiency and care for everyone involved.
On the front lines of today’s healthcare experience and engagement, contact centers are set for a profound transformation. Generative AI (GenAI) and agentic learning systems are evolving to operate with greater autonomy and adaptation through continuous feedback. Read new insights on this topic in “Reimagining the Healthcare Contact Center: The Impact of Generative AI on Payers and Providers,” by Sagility’s Associate Vice President, Business Transformation Abhishek Danturti Sharma, as published in Call Center Times.
Today’s large language models and GenAI are driving optimized experience at a scale humanly impossible before. In the HIT Consultant article “How GenAI Solves for Challenges in the Healthcare Front Office,” find out more about how GenAI is transforming the front-office customer service touchpoint, with insights from Sohail Djariri, Chief Growth Officer, Sagility, and Kevin Terrell, Cofounder and CEO, BirchAI, a Sagility company.
Older people are hoping to spend their golden years in a familiar and comfortable place — their home. The aging population creates a growing need for focused aging in place services. Sagility is happy to share insights by Susan Smith, our Director of Clinical Practice. In this article “Meeting the Aging-in-Place Member at Home,” published in McKnight’s Home Care, she shares key factors influencing the scope and effectiveness of an emerging program
The old adage “build it and they will come” is a recipe for disaster when it comes to electronic prior authorization. For what it’s worth, a poor portal experience will not improve provider collaboration; however, it will cause undue frustration for practices. Glean insights into enhancing portal experience in this a First Report Managed Care article by Krithika Srivats, MSOTR, SVP, Clinical Practice and Products, Sagility; Nikki Henck, Senior Director, Utilization Management, Sagility.
Our nomination highlighted Sagility’s significant employee satisfaction increases and commitment to our Voice of Employee feedback and leadership action planning.
Today’s health plans continue to pay healthcare providers significant penalties and interest when they violate prompt pay laws for clean claim-delayed processing due to various processes, disparate systems, and dependencies on functional groups. In this MedCity News article, read how health plans can reduce late payment interest by up to 25% year over year, with insights from Sagility experts Manju Byrappa, Vice President, Solutions and Practice Lead and Zaffar Kahn, Associate Vice President of Transformation & AI.
Payer-provider collaboration represents a crucial opportunity to bridge the gap between those who provide care and those who finance it. Find out how healthcare organizations can leverage opportunities in critical areas in this First Report Managed Care article, authored by our experts Krithika Srivats, Senior Vice President, Clinical Practice, Sagility, and Jason Besterfeldt, Vice President, Sales, Sagility.
Already challenged with cost, care, and administrative pressures, health care organizations are now staring down a daunting talent supply-and-demand gap. This shortage will negatively affect affordability and access to care for consumers and bears profitability risks for providers, payers, and other health care stakeholders.
Cyberattacks on healthcare organizations call for a security refresh. In the Medical Economics article "Information Security and Compliance: Solving for 3 Security Pain Points" Sagility Director of Technology Ram Shastry shares key guidance.
New ratings methodology has raised the bar for healthcare Star success, so it’s a good time to redefine what high Star ratings means to the members. This means connecting the dots of experience for satisfied members and true value creation for respective Medicare plans. Health plans can meet upgraded expectations with focus beyond customer service—as supported by healthcare domain knowledge and a high-touch experience across three critical areas: Claims, Medical Management, and Provider synergies.
In this article recently published in Health IT Answers, our thought leaders Carlos Estrada, M.S., Vice President of Information Security, Sagility, and Matthew Betts, Director, Provider Client Services, Sagility, share guidance on how healthcare organizations can navigate today’s ransomware attacks and data breaches.
Read this Medical Economics article as Nikki Henck, Senior Director of Utilization Management at Sagility, unveils three pivotal insights into prior authorization transformation. Discover how recent CMS regulations are set to automate PA processes, slashing wait times.
Sagility to transform member, patient and provider interactions using BirchAI’s SaaS platform
Delve into the McKnight’s Home Care analysis by Lisa Doggett, MD, MPH, FAAFP, Senior Medical Director at Sagility, in her article "Addressing the public health toll of falls." With a professional and compassionate approach, Lisa illuminates the pervasive impact of falls, offering real-world examples and evidence-based strategies for prevention.
As today’s hospital margins are increasingly in the red, and health systems are asked to do more with less, all eyes are on cost removal. According to a survey on healthcare outsourcing conducted by Black Book Market Research LLC, 90% of healthcare executives are exploring cost savings through relationships with third-party vendors.
Provider network teams are faced with the challenge of enhancing healthcare delivery while ensuring provider satisfaction remains at its zenith. In an insightful MedCity News article, Lohit Thammanna, Manager Operations and Practice, Sagility, sheds light on "Unlocking 4 Areas of Provider Network Value.”
Expert authors Krithika Srivats, Sr. Vice President, Clinical Practice and Products, Sagility, and Belinda Pentony Cridge, Vice President of Client Services, Sagility, made it to the Health IT Answers list of “Most read thought leader posts” for December. Check out “4 Ways to Win with Claims Denials”— and find out how to significantly decrease denials costs.
Health care can no longer afford to ignore tech disruption and enablement. From disparate data sources across multiple stakeholders to tedious, error-prone operational tasks, the industry’s challenges are uniquely suited to transformation driven by generative AI. Every day, the industry increasingly embraces these disrupters, with breakthrough transformation examples like AWS HealthScribe for clinical transcription and Epic integrating GPT-4 into its electronic health record.
Discover how BPO is no longer just about cost-cutting; it's a supercharged strategy that drives scalability, savings, and, most importantly, unprecedented outcomes. Find out more in our blog/article, “BPO, Supercharged: Business Process As A Service Drives Scale, Savings While Exponentially Enhancing Outcomes,” by Sagility team members Srikanth Lakshminarayanan, Umesh Chandorkar and Nikki Henck.
Sagility LLC, a leading provider of technology-enabled business process management (BPM) services, announced today their acquisition of Chandler, Arizona-based Devlin Consulting, Inc. (DCI). For the past 28+ years, DCI has made a name for itself as a healthcare technology services company providing payment integrity services to several of the country’s leading health plans.
Health plans are unnecessarily burdened by administrative tasks such as prior authorization—a costly bottleneck to optimized care and operational outcomes. Recent American Hospital Association (AHA) research states that that 95% of providers spend increasing time seeking prior authorization approval.
Take a look into this month's cover story series of the companies, trends and ideas that are shaking things up and reshaping the contour of how healthcare is paid for and delivered. Below spotlights business process management firm Sagility and its chief growth officer, Sohail Djariri, who breaks down payment integrity when it comes to fraud detection.
