Members Don't Understand Their Coverage
Most members can't answer basic questions about their plan. Without clarity, they avoid care or use it incorrectly — costing the plan and the member more.
Members Have Coverage. Most Won't Use It.
80% of at-risk members go unreached. 85% are confused about their benefits. 60% still don't act on care plans. Our Member Engagement Platform fixes all three.
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Why Most Member Engagement Programmes Fall Flat
The tools health plans use to reach members weren't built for real people. Every failure below compounds into lower care utilisation, higher costs, and disconnected members.
The App Nobody Opens
Downloaded once, never returned. Apps built around documents and ID cards give members no reason to come back.
Generic Outreach Gets Ignored
Same newsletter, every member, regardless of condition or language. Generic outreach feels like marketing — personalised outreach feels like care.
At-Risk Members Are Hardest to Reach
Those who need support most are least likely to respond to a letter or unknown number. Standard outreach misses them entirely.
Trust Is Low and Getting Lower
Confusing bills and unexpected denials have caused members to disengage. Rebuilding trust requires interactions centred on health, not admin.
What the Platform Delivers
Six capabilities working together — every member interaction, every care gap, every outreach moment handled through a single AI-driven platform.
Member Experience
Personalised Member App, AI Care Navigator, Benefits Navigation & Cost Tools, Digital ID Cards & Claims Status.
Outreach & Engagement
Intelligent Care Gap Outreach, Multi-Channel Orchestration, Preferred Language Delivery, AI-Assisted Outbound Calls.
Care Management
Care Plan Management, Adherence Monitoring & Alerts, Post-Discharge Follow-Up, Chronic Disease Support.
Operations Intelligence
Member Activation Dashboard, Care Gap Closure Tracking, Outreach Performance Analytics, Quality Measure Performance.
What the Platform Delivers
Six capabilities working together — every member interaction, care gap, and outreach moment handled through a single AI-driven platform.
Everything Your Operations Team Can Track
Real-time visibility across your member population — activation trends, care gap closure, outreach performance, and quality measures. A live view your entire team can act on.
Member Activation & Engagement Dashboard
App downloads, active usage, and engagement trends by segment and geography. Care gap closure rates by type and channel. Outreach delivery, open, and conversion rates broken down by channel, language, and segment.
Care Plan Adherence Tracker
Real-time adherence by care plan step. Flags members who've fallen off in the last 7 days. Escalation queue for coordinator follow-up. Readmission risk scores updated continuously.
Quality Measure Performance
Real-time HEDIS, Stars, and equivalent metric tracking — with the specific member actions needed to close gaps before the measurement period ends. Satisfaction signals and NPS in one view.
What Plans Are Seeing After Going Live
Each result traces to a specific gap — unreachable members, unfollowed care plans, outreach that missed. Click through to see what changed.
Book a Member Engagement Demo3×
Increase in active app engagement within 90 days. Members who never returned now check care gaps, book appointments, and query benefits monthly. — Regional Health Insurer, Bengaluru
68%
Care gaps closed in the quarter — up from 29%. AI-personalised outreach through the right channel moved members from awareness to action. — Managed Care Organisation, Hyderabad
44%
Reduction in avoidable ED visits among high-risk members on active care plans. When members know where to go, they stop going to the nearest ED. — TPA, Delhi
$380
Savings per member per year through care navigation and gap closure — within the $240–$480 benchmark. The platform paid for itself in the first plan year.
4.6×
Outreach response rate improvement after switching from generic blasts to AI-personalised messaging. Same population, same care gaps — entirely different outcome.
91%
Member satisfaction among active platform users — vs 54% among non-users in the same plan. Members who feel guided renew at materially higher rates.
Who This Platform Is Built For
Built for the full ecosystem of health insurance and managed care — national insurers, government schemes, TPAs, and employer health plans.
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Health Insurance Companies
Health Insurance Companies
Manage large, diverse populations with variable engagement. AI personalisation at scale moves the needle on care gap closure, quality metrics, and retention — with a single operational view across your entire population.
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Managed Care Organisations
Managed Care Organisations
Contracts tied to quality performance need measurable results. Drive care gap closure and adherence improvement — and generate the data to prove it at renewal.
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Third Party Administrators
Third Party Administrators
A branded, AI-personalised member experience is a competitive differentiator in TPA contract conversations — and measurable engagement improvement is something you can demonstrate at renewal.
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Government Health Schemes
Government Health Schemes
Scheme beneficiaries are often the least engaged — not because they don't need care, but because navigating the system feels overwhelming. AI care navigation in regional languages, through channels people actually use, changes that.
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Corporate and Employer Health Plans
Corporate and Employer Health Plans
Give every employee the tools to use preventive care, manage chronic conditions, and make informed decisions — and give HR leadership the data to see whether it's working.
Integrates With Every System Your Members' Data Lives In
Every integration is scoped during implementation — health system data, regional languages, privacy frameworks, app standards, and quality measure reporting for India and global deployments.
Data Privacy
Healthcare Data Privacy
Privacy and security frameworks applied across every member data store, communication channel, and access control in the platform.
Health System Integration
Clinical & Claims Data Integration
Standard integration with your core administrative system, claims database, clinical data sources, provider directory, and ABHA.
Regional Languages
Indian Language Support
Member app, care navigator, and all outreach communications delivered in the member's preferred language — at scale.
Quality Measures
Quality Reporting Standards
Real-time quality measure tracking built into the operations dashboard — aligned with the frameworks your plan is measured against.
App & Accessibility
Mobile App Standards
Consumer-grade mobile experience built to accessibility standards across both major platforms — no compromise on usability.
Outreach Channels
Multi-Channel Delivery
Every outreach channel members actually use — orchestrated by the AI communication profile engine and delivered through compliant, auditable pipelines.
Coverage Is Not Care. Engagement Is the Bridge Between Them.
Your members are paying for a plan that could genuinely improve their health — if they knew how to use it. Plans that invest in real engagement see it in their quality metrics, retention numbers, and population health outcomes.
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Frequently Asked Questions
[ 1 ]
How personalised does the outreach actually get? Is this just mail merge?
Far more than mail merge. The engine considers health conditions, care gaps, engagement history, preferred channel, language, and optimal send time. Two members with the same diagnosis can receive entirely different outreach based on their individual profile — that's what drives response rates generic outreach can't match.
[ 2 ]
Can the AI Care Navigator handle sensitive health topics appropriately?
Yes. It handles chronic disease, mental health, maternity, and other sensitive topics with clinical accuracy. When a topic requires a human, it escalates to a care coordinator with full conversation context — the member never has to repeat themselves.
[ 3 ]
Does this platform support regional languages for Indian member populations?
Yes. The app, care navigator, and all outreach support Hindi, Tamil, Telugu, Kannada, Marathi, Bengali, Gujarati, and more — based on member preference and configured at scale for government scheme requirements.
[ 4 ]
How does the platform integrate with our existing member data and claims systems?
Via standard APIs — HL7 FHIR R4, ABHA, NHCX, and X12 EDI. Member profiles draw from your admin system, claims database, and clinical data sources so personalisation is based on real coverage and health history, not assumptions.
[ 5 ]
How do we measure whether member engagement is actually improving health outcomes?
The dashboard tracks leading indicators (care gap closure, adherence, follow-up completion) alongside lagging outcomes (readmissions, ED utilisation, chronic disease control) — and attributes improvements to specific interventions.
[ 6 ]
What does implementation look like and how long does it take?
Most plans go live within 8–12 weeks. We handle data integration, app configuration, and population setup. Your team's main involvement is reviewing clinical criteria and outreach content.
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