How the HealthEdge® AI Summarizer Empowers Teams to Deliver Personalized Care at Scale

Care managers are responsible for far more than delivering care. They coordinate member communication, update health records, navigate program changes, and play a crucial role in ensuring compliance—all in a dynamic environment. These are all tasks in which summarizing data is critical to providing the right care at the right time. In these multitasking, context-switching scenarios, care managers must understand each member’s latest conditions, care plans, and history every time they assist them to deliver informed, high-quality interactions.

Data available to care managers is meant to support and inform better care, engagement, and accountability, but culling and making sense of all of it often results in information overload, making it harder to focus and efficiently draw the insights needed for personalized member support. Manual prep is time-consuming and mentally taxing, hindering staff satisfaction and caseload efficiency.

Introducing the HealthEdge AI Summarizer

The AI Summarizer for HealthEdge Wellframe streamlines care managers’ preparation for member interactions by creating concise, actionable AI-generated summaries of the member’s data. With this capability, care managers can quickly understand critical details without sifting through long records. This is especially helpful for members with complex health histories. As a result, staff can deliver more personalized and timely responses, improving care outcomes and the overall member experience.

Use AI to Empower Health Plan Staff and Enhance Member Interactions

Health plans can significantly improve staff efficiency and member care quality using the AI Summarizer. Many care managers are expected to work on larger caseloads

that often include members with complex health issues. By generating concise summaries of member data, care managers can quickly understand essential information and action items without reviewing the full history and detailed notes. This time-saving feature is also highly beneficial when co-managing members or covering for other staff, helping ensure continuity of care and consistent support for members.

With the AI Summarizer, care teams are able to:

• Reach More Members — With reduced time spent on data review, care managers can engage with a larger number of members effectively, ensuring broader coverage and support across their assigned population.
• Reduce Cognitive Load — The AI Summarizer distills complex member histories into easily digestible summaries, significantly decreasing the mental strain on care management staff. This reduction in cognitive load leads to improved focus and decision-making throughout the day, as well as improved satisfaction.
• Practice at the “Top of License” — By automating time-consuming data synthesis, the AI Summarizer frees care managers to utilize their expertise where it matters most. They can focus more on complex case analysis, strategic care planning, and direct member interactions.

Improve the Quality of Member Interactions

The HealthEdge AI Summarizer doesn’t just help expand the breadth of care delivery—it also enhances the quality of interactions between care managers and members. The AI Summarizer overview empowers care teams by delivering:

• Comprehensive Understanding — Care managers begin each interaction with a holistic view of the member’s health journey and potential areas of concern. This comprehensive understanding allows for more personalized and relevant discussions.
• Increased Preparation Time — With less time spent on data review, care managers have more time to prepare for each interaction, developing targeted questions and tailored care strategies focused on the future.
• Improved Engagement — Using AI-powered insights, care managers can engage members in more meaningful conversations without searching for information during a conversation or simply proceeding without essential details. This leaves time to address specific health concerns and check on progress points that might have been overlooked.
• Timely Interventions — The AI Summarizer helps highlight potential issues or changes in a member’s health status, enabling care managers to provide interventions and support at the right time for the member.

By leveraging AI Summarizer, health plans can significantly enhance care management operations. This leads to more efficient staff performance and, ultimately, improved health outcomes for members.

Transform Member Engagement with AI Summarizer

AI Summarizer represents a significant step forward in our mission to drive digital transformation in healthcare. As we continue to innovate and push the boundaries of what’s possible with AI in healthcare, one thing remains constant: our commitment to providing health plans with the tools they need to deliver exceptional care in an increasingly complex healthcare environment.

Advancing an Enterprise AI Strategy for Health Plans

AI Summarizer is one example of how HealthEdge applies AI to enhance health plan performance and improve member outcomes as part of our broader Enterprise AI strategy. We’re advancing AI across the healthcare journey by targeting three strategic areas:

• Intelligent claims operations – Leverage AI to adopt advanced automation for every aspect of claims processing, including contract management, auto-adjudication, fraud detection, and improved financial accuracy.
• Proactive and integrated care – Improve clinical and cost outcomes while driving care team quality and efficiency through predictive insights, automation and tailored care support.
• Elevated member experiences – Enable personalized experiences at scale to meet member and provider needs across intelligent content, workflows and data.

The AI Summarizer fits directly into the second pillar—proactive and integrated care—by helping care managers quickly understand a member’s full health journey and act on the most relevant information.

To ensure that innovations like these are deployed responsibly, HealthEdge follows a robust Enterprise AI framework built on four foundational pillars:

1. Healthcare AI Principles – We align with emerging healthcare industry healthcare AI principles, coalitions, and frameworks such as the published Healthcare AI Commitments and the CHAI guidelines to build safe, equitable, and transparent AI solutions.
2. Responsible AI – Our dedicated enterprise AI risk governance incorporates frameworks such as the NIST AI RMF 1.0.
3. Collaboration & Partnership – We foster strong partnerships with customers, end users, and industry stakeholders to develop innovative AI-enabled solutions aligned to the evolving needs of our customers.
4. Operational Value – We are committed to developing AI-enabled features that generate meaningful outcomes for health plans, empowering them to adapt and evolve with dynamic market changes and demands.

HealthEdge is actively integrating AI across its product suite, including HealthRules® Payer for claims automation, GuidingCare® for care management, and HealthEdge Source for payment integrity.

To learn more about how HealthEdge is enabling health plans to transform operations and care delivery using AI, read the data sheet.