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This case study explores how a leading national healthcare payer identified millions in annual savings by using Agentic AI to enhance utilization management (UM) and care management (CM).

The organization faced issues such as overutilization and complex processes that required significant manual intervention. Productive Edge led an AI Action Planning Workshop, which resulted in use case prioritization and a roadmap.

Quick wins in UM included an assistant that streamlined the information needed by staff to create service plans. CM innovations involved data synthesis for and predictive analytics. The pilot program confirmed ROI and user benefits and offered a roadmap for scaling AI. Key lessons highlight strategic planning and change management.

Vendor:

Productive Edge

Posted:

Feb 7, 2025

Published:

Feb 7, 2025

Format:

PDF

Type:

Case Study