6 reasons leading health insurers are choosing AI triage and care navigation
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In today's competitive market of private medical insurance, the formula for success is changing. It's no longer enough to simply offer a comprehensive network; leading health plans are winning by creating a truly member-centric experience.
The challenge is to provide this superior service while actively managing rising healthcare costs.
This is why top insurers are turning to a proven solution: AI-powered triage and care navigation.
Infermedica’s AI encourages members to engage with their insurance provider by offering clinically validated healthcare guidance that saves time and money for everyone involved. It’s not just a digital tool; it’s a strategic asset for building a more efficient, engaging, and cost-effective health plan.
Here’s how it works.
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AI-powered triage and care navigation has proven results for healthcare insurers. Illustration by Anna Warda.
Building member loyalty and engagement via easy access to care
Member loyalty is built on trust and a positive experience. When members face a health concern, they often feel uncertain and anxious. A confusing website or long call-center queues can amplify this frustration. They want to know that help is at hand and that it’s easy to access, right when they need it.
By providing an intuitive, 24/7 digital tool, you empower members to understand their symptoms and take control of their health journey.
Take a look at our real-world data that shows how integrating Infermedica Triage helps healthcare organizations, including insurers, to provide more well-rounded access to care.
Implementation of Infermedica’s virtual triage has improved self-assessment completion rates by 71%—from 49% to 84%—showing that users find digital tools easy and accessible.
20% of interactions took place outside of regular operating hours—Infermedica’s virtual triage directed 48.4% of these cases to lower acuity care than the user initially intended to seek.
20% of users reported at least one mental health symptom—Infermedica Triage includes 1800 symptoms, including support for mental and sexual health.
76% of users with symptoms of a heart attack didn't plan urgent care help—demonstrating Triage’s role in early detection and encouraging access to timely intervention.
80.1% of patients indicated substantial overall satisfaction with the experience and value delivered by Infermedica solutions.
Access to healthcare is a driving factor in increasing member engagement and loyalty. Get in touch to chat with our team about your specific health insurer goals.
Provide clear care pathways, tailored to your needs
We know that 74% of members don’t know the right level of care for their needs. For these members, navigating a complex healthcare system adds additional stress on top of their healthcare concerns.
We work with health insurers to replace uncertainty with clarity.
After assessing a member's symptoms, the triage solution provides a recommendation for the most appropriate level of care. It connects them directly to in-network services tailored to your organization’s set-up—whether that’s telehealth services, a local clinic, self-care advice, or any chosen endpoint.
Our collaboration with a large Australian health insurer led to a 91.3% drop in care uncertainty, fostering a sense of confidence and building a stronger, more trusting relationship between the health plan and its members.
By seamlessly integrating Infermedica’s virtual triage tool into your digital health system, you can ensure members use your network effectively and feel supported at every step.
Reduce overutilization of high-cost services
One of the biggest drivers of unnecessary cost is the misuse of high-acuity services. Our AI triage directly addresses this by guiding members to the right level of care from the start. The impact is significant and measurable.
By intelligently navigating members away from unnecessary emergency visits, one health insurer saved $284.55 per encounter after integrating Infermedica’s virtual triage solution. Furthermore, the integration allows the insurer to effectively navigate members to lower-acuity care settings or provide accurate guidance on how to treat themselves at home (the company is also seeing a 56.5% increase in members choosing to self-care at home).
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Lower claims costs
Effective cost management goes beyond just reducing overutilization; it involves proactive care.
Our platform lowers long-term claims costs by enabling early intervention. The symptom checker can help identify members with escalated health risks, allowing for timely outreach and preventative care. For instance, our research found that individuals with obesity were twice as likely to report comorbidities during triage.
By identifying these risks early, you can guide these members toward care management programs, preventing the progression to more complex and expensive long-term conditions.
Utilize data effectively for proactive population health management
The anonymized data generated through millions of triage encounters provides invaluable insights into the health of your member population. This data allows for more sophisticated risk stratification, helping you understand prevalent conditions and emerging health trends.
These insights enable you to move beyond one-size-fits-all wellness programs to craft targeted, effective healthcare campaigns that address the specific needs of different member segments, maximizing engagement and improving outcomes.
Be digitally connected
An AI-powered triage tool should be a crucial part of your digital ecosystem, not another siloed app.
We designed our solution to integrate seamlessly with your existing digital offerings and to be tailored to your specific business goals. It acts as a "Virtual Front Door," creating a unified experience that connects members to the rest of your network. This ensures your digital tools work together, delivering maximum value for both you and your members.
Get in touch to learn about iFrame or API integrations.
By embracing this clinically validated and globally trusted technology, health plans are not just adding a new feature—they are building a smarter, more efficient, and member-centric foundation for the future.
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