From reactive systems to proactive actions: How AI is powering the next era of health engagement

Summary

• AI moves healthcare engagement from reactive to proactive, enabling personalized outreach, closing care gaps, and driving higher member satisfaction.
• Purpose-built healthcare AI powered by rich, contextual data delivers seamless, trusted experiences while reducing costs and unlocking operational efficiency.
• Orchestrated AI agents augment the workforce, accelerate digital adoption, and create significant value—boosting retention, revenue, and long-term growth for payers.

Digital transformation has long been a buzzword in healthcare, promising a future of streamlined processes and improved patient experiences. Yet, for all the progress, a core challenge persists for most organizations: digital adoption. How do we truly convert digital access into meaningful action?

We’re now at an inflection point, shifting from simply needing a platform to strategically deploying AI. The conversation has evolved to: How do we leverage AI effectively to truly understand our members and unlock the vast amounts of data we possess? Members have always yearned for seamless, personalized, and responsive experiences. What’s new is that AI finally makes it possible to meet these expectations at scale and in a truly cost-effective way.

The urgency to act is undeniable. Organizations that fail to act now will be left behind. AI is the key to unlocking the immense, unrealized potential of your data and digital investments. It’s the pathway to closing care gaps, capturing value, and fundamentally transforming the member experience.

Data, Not Just AI, Drives Value

Generative AI models are rapidly becoming a commodity. They’ll be widely available, but the real differentiator isn’t the AI itself. It’s the intelligence and the data that fuel it. Unlocking meaningful engagement hinges on your ability to contextualize fragmented data. Think of it as a “data flywheel”:

1. Comprehensive data fuels a deep understanding of the member.
2. This intelligence powers personalized, proactive actions.
3. These actions generate new data and insights, which further refines the experience.

At League, we’ve built our AI solutions around this principle. By drawing from over 100 petabytes of data across 63 million members in five countries, our platform anticipates needs, simplifies decisions, and drives 3x higher engagement. It’s not just about processing data, it’s about remembering who your members are, what they’ve experienced, and what they need next. That continuity, what we call “intelligent memory”, is what moves AI from generic to truly impactful.

Most consumer AI tools often lack the specific context and workflow integration necessary for healthcare. My own recent experience with a general AI for a medical concern underscored this point. The answers were entirely off-base because the AI lacked specialized data and purpose-built workflows. You wouldn’t hire a mathematician to be a doctor, and the same principle applies to AI. 

That is the difference. Purpose-built AI for healthcare incorporates clinical relevance, safety protocols, regulatory understanding, and deep domain expertise. When grounded in a rich, intelligent data asset, it transforms digital access into meaningful health action and delivers trusted, relevant experiences members can rely on.

The Conversational Member Experience

The way members interact with their health plan is undergoing a profound transformation. We’re moving beyond the mobile-first UI to an AI-first UI, characterized by conversational interactions, fewer clicks, and just-in-time surfacing of content. This shift is directly influenced by consumer demand. The exponential adoption of tools like ChatGPT has set new expectations. Your members now expect this level of conversational, responsive experience from their healthcare providers and payers. It’s a fundamental change in the method of interaction, further amplified by advancements in voice technology.

While much of the current buzz around AI agents focuses on reactive customer service—deflecting calls or enabling self-service when a member reaches out—the true promise of AI in healthcare lies in proactive outreach at scale. Agentic AI enables payers to anticipate needs and initiate action:

• Refill reminders
• Screening nudges
• Guided benefits navigation
• Personalized recommendations

This isn’t just about convenience. It’s often a matter of life or death. The altruism and immense benefit associated with proactive health outreach far outweigh a generic marketing click. This ability to deliver proactive, personalized engagement, anticipating needs and guiding members, is where AI truly shines for payers.

Orchestrating AI for a Seamless Member Experience

The last decade saw a wave of digital health solutions, often resulting in a fragmented ecosystem of disconnected point solutions and partnerships. We face the same risk with AI. Without careful orchestration, AI agents could simply add another layer of chaos, leading to a disconnected experience that frustrates members and erodes the customer relationship.

Just like employees, AI agents need managers. True engagement demands an omni-channel presence that feels completely seamless to the member. This means orchestrating a single, unified journey across all channels and all AI agents. It’s not enough for agents to act as a “central brain” if that brain itself isn’t managed. The goal is a truly integrated experience where answers are delivered immediately, and actions are proactively taken, often with a single click. This prevents members from navigating four different steps to access a point solution, ensuring they can easily engage with their health.

Partner to Accelerate AI CX

As AI-powered capabilities become more accessible, many organizations will consider building in-house. However, this often underestimates the complexity of creating a truly effective healthcare CX engagement platform with AI. While it might seem easier with readily available AI platforms, going it alone can lead to even greater disconnected experiences, contradicting the very promise of AI-driven personalization.

AI’s Workforce Impact: Augment, Don’t Just Replace

A critical consideration for healthcare leaders is how AI agents will affect their talent and HR strategies. This isn’t a simple question of “rip and replace.” There are three distinct ways to think about AI’s impact on your workforce:

1. Replacement: Applying AI agents to automate tasks and remove human roles, primarily for cost efficiency.
2. Augmentation: Integrating AI tools to make existing teams more productive. For example, ambient listening and scribing solutions for clinicians can significantly reduce administrative burden, allowing them to better focus on patients.
3. New Talent: Deploying AI to fill critical resource gaps and enable entirely new capabilities. In a landscape constrained by a shortage of clinicians and support staff, AI agents can represent a new kind of “talent” that delivers care previously impossible due to lack of human resources.

Each scenario carries a different value proposition: cost savings, increased productivity, or unlocking new, previously unattainable value. For payers, this translates directly to areas like customer operations, care management, case management, patient outreach, and digital marketing.

The Future: High Satisfaction, Lower Cost

Healthcare experiences traditionally suffer from a dichotomy: low Net Promoter Scores (NPS) coupled with high costs to deliver. The true promise of AI lies in flipping this script. Imagine a future where you can drastically grow member satisfaction (high NPS) while simultaneously reducing the cost to serve and the overall cost of care. We can achieve this through automation, personalization, and by introducing a new kind of labor and talent—AI agents—to augment and expand our human capabilities.

For US payers, this translates directly to growth and brand reputation. Improving the member experience through AI isn’t just a nicety. It’s a strategic imperative to grow and retain members. Digitally engaged members create significantly more value for payers. In fact, our data indicates the potential: 14x higher value creation from a digitally engaged member ($800+) vs. a non-digitally engaged member ($55/member). Furthermore, proactive engagement through AI can lead to strong outcomes, including a potential 30% increase in monthly active users and a 60% increase in health recommendation completion rate.

The time to act is now. The market is evolving rapidly, and AI offers a unique opportunity to lead the next wave of experience transformation. By strategically embracing AI, you can drive growth, retain members, win market share, and increase revenue, all while simultaneously enhancing productivity and efficiency across your organization. It’s time to transform healthcare from a high-cost, low-satisfaction model to one that delivers exceptional experiences at a far lower cost.