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For Health Plans

Every plan workflow, transformed by agents.

Replace fragile scripts and manual queues with healthcare-native agents that listen, decide, and act - across utilization management, care management, member services, and provider operations. Live in days, not quarters.

Outcomes at Health Plan scale

Measured in production, not pilots.

Numbers from live deployments across regional and national plans powered by Diagnostic Robotics.

40M+
Members touched by Diagnostic Robotics agents and models
DR Platform
35%
Reduction in avoidable ED utilization for at-risk cohorts
DR Platform
Throughput increase on care management outreach
DR Platform
92
Member NPS on Maxine voice agent interactions
DR Platform
The reality

Health plans are paying a hidden tax on broken operations.

The average plan spends 15–20% of premium on administration. Member NPS sits below 30 industry-wide. Care managers spend more than half their day on documentation and phone tag. Prior auth backlogs run weeks deep.

Most "AI" promises haven't met the reality of regulated, clinically-nuanced workflows. Until now.

Where the cost lives
Per member per month
  • Member services$32 PMPM
  • Utilization mgmt$24 PMPM
  • Care mgmt outreach$18 PMPM
  • Provider ops$15 PMPM
The AI Arms Race

Providers are scaling AI faster than payers can respond.

The 2026 Oliver Wyman Healthcare RCM Survey put numbers on what your CFO is already seeing: 80% of health systems are deploying generative AI in revenue cycle today - up 38 percentage points in under two years. Every claim now arrives more thoroughly documented, more aggressively coded, and submitted faster than any human team can review.

AI enablement isn't optional anymore. It's the price of admission.

Provider AI velocity
Oliver Wyman · 2026
  • Health systems deploying GenAI in RCM80%
  • Adoption increase since 2024+38pp
  • Providers growing AI spend through '2870–90%
  • Reduction in coding time, complex cases46%
  • "No-regret" AI investments per CFOs92%
Use Cases

Six functions. One platform. Real outcomes.

Each agent is a configurable starting point - not a closed black box. Your team owns the policy. Our agents do the work.

Utilization Management
Prior Auth Triage Agent

Reads the request, gathers missing clinical context, routes routine approvals, and prepares full clinical rationale for nurse review on the rest.

↓ 67%
turnaround time
↑ 3.4×
nurse capacity
Care Management
Outreach & Intake Agent

Calls high-risk members, conducts structured assessments, books appointments, and hands warm transfers to care managers with full context.

70%
reach rate
↑ 4×
case throughput
Member Services
24/7 Member Concierge

Eligibility, claims status, benefit lookup, ID card, find-a-doc, nurse-line triage. Voice or chat. Multilingual. Escalates with full context.

↓ 58%
AHT
92
NPS
Provider Operations
Credentialing & Disputes Agent

Drives credentialing intake, resolves provider data discrepancies, and triages claim disputes - turning 30-day SLAs into same-week resolution.

↓ 75%
rework
↓ 62%
dispute backlog
HEDIS / Stars
Gap Closure Agent

Identifies open gaps, prioritizes by Stars impact, conducts member outreach, books closures, and updates supplemental data - all year, not just Q4.

↑ 0.4★
Stars lift
↑ 28%
closure rate
Risk Adjustment
Coding & Chart Review Agent

Reviews charts at scale, surfaces suggested HCC codes with evidence, and supports coder workflows. Compliant, auditable, RADV-ready.

↑ 5.1×
coder output
97%
precision
How it works

From contract to live, in weeks.

Agents deploy on top of your existing systems - no rip-and-replace. Most customers are in production on the first workflow within 6–8 weeks.

Step 1
Connect

Read-only integration with your claims, EHR, telephony, and CRM stack. SOC 2 + HIPAA from day one.

Step 2
Configure

Pick from workflow templates. Encode your policies. Co-design with our clinical solutions team.

Step 3
Run

Agents work alongside your team. Real-time monitoring, weekly outcome reviews, continuous tuning.

Integrations

Works with the systems you already run.

Epic
EHR
Oracle Health
EHR
Salesforce Health Cloud
CRM
HealthEdge
Core admin
TriZetto / Facets
Core admin
Five9 / Genesys
Telephony
Snowflake
Data
Databricks
Data
Trust

Built for healthcare. Governed end-to-end.

HIPAA-eligible
SOC 2 Type II
NIST AI RMF
Policy-as-code
Full audit trail
Clinician-reviewed
Get started

Show me what's possible for my plan.

Tell us your top three operational pain points. We'll map them to live use cases and show you the outcome curves from comparable plans.

Book a working session