AI in Contact Centers: Takeaways for Care Management Teams

Key Takeaways:

• Generative AI has the potential to increase contact center capacity by up to 25%, enabling healthcare teams to maintain efficiency while prioritizing empathy and personalized care.

• Many Payers enable the AI summary capability of their existing phone platform, however, these solutions lack the deep domain expertise a healthcare-specific solution provides.

• Successful AI implementation in healthcare requires balancing automation with augmentation, allowing care managers to focus on meaningful member interactions rather than routine tasks.

• The importance of clean data and robust governance cannot be overstated in healthcare AI deployments, as these are key to minimizing risks and maximizing the benefits of AI in patient care.

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Top Insights for Payers: Maximizing Impact with Generative AI

As the healthcare industry continues to evolve, payers face a growing demand to improve efficiency, member experience, and operational scalability. The proliferation of GenerativeAI (GenAI) creates an opportunity for Payers to maximize their impact on members while improving their operation’s efficiency.

Here are the top insights and actionable takeaways for Payers.

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AI in Healthcare Contact Centers: The Promise of Efficiency and Empathy

Across industries, ~40% of working hours have a high potential to be impacted by GenAI and large language models (LLMs); healthcare is even higher at 62%¹. One of the most powerful opportunities AI brings to healthcare contact centers and care management teams is the ability to increase capacity by up to 25%²—a figure that resonates strongly in an industry that is being squeezed to do more with less.

With 40% of working hours across industries potentially impacted by large language models (LLMs) and 62% of total hours in healthcare being focused on language tasks, it’s clear that generative AI (GenAI) is poised to make a significant mark on the healthcare sector. Healthcare payers, in particular, stand to benefit greatly from GenAI’s ability to streamline operations and enhance employee productivity.

According to Accenture, this newfound efficiency doesn’t come at the cost of human interaction. In fact, AI solutions like agent assist can reduce administrative burdens and allow care managers to focus more on what matters: empathy, active listening, and health advocacy.

In today’s environment, care managers often juggle multiple systems, from CRMs to administrative tools, leading to inefficiencies that detract from the quality of member interactions. Laguna’s cross-platform AI solutions change the game by integrating seamlessly across all cloud-based systems, cutting through the spaghetti of tech stacks that many organizations struggle with. As AI takes over routine tasks—like call authentication, summarization, and knowledge retrieval—care managers can focus on what really matters: delivering better member outcomes and building deeper, more personalized connections. This repositions care managers as both trusted navigators and translators for members in the complex landscape of healthcare, all while improving organizational performance and profitability.

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Balancing Automation and Augmentation: The Key to Sustainable AI Adoption

While automation promises to optimize operations, healthcare leaders must also think strategically about how AI fits within their organizational goals. The key to sustainable success is understanding the balance between automation and augmentation.

Both are key to implementing AI for the greatest impact. Though automation may be top of mind to tackle, augmentation—empowering care managers rather than replacing them—remains a critical focus for payers. Laguna Health, for example, has centered its AI solutions on both automating administrative tasks and augmenting human roles, helping care managers focus on member care and empathy, not paperwork. This aligns with Accenture’s point that AI-driven augmentation enables staff to maintain human oversight while improving outcomes and efficiency.

Healthcare payers seeking to implement AI focus on four core business opportunities:

• Seeking and Scaling New Growth
• Improving Health Outcomes
• Empowering Your People
• Optimizing Operations

Each of these business goals is driven by AI’s ability to reshape the workforce, either through automating repetitive tasks or augmenting care managers’ abilities with real-time insights. By strategically integrating AI into employee applications—particularly through agent-assist tools—healthcare organizations can mitigate the challenges of adopting new technology while ensuring responsible, ethical deployment.

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Responsible AI: Key Considerations for Payers

AI’s potential in healthcare is vast, but executives must tread carefully when implementing GenAI in their contact centers. Accenture emphasized the need for data hygiene—clean, curated data is a non-negotiable foundation for any successful AI implementation. Without high-quality data, AI deployments can fall short of expectations, causing issues like bias or “hallucinations” in GenAI responses.

Additionally, transparency around AI usage and obtaining member consent are critical to successful implementation. As AI is still a relatively new technology, members may hesitate to grant consent, making it essential to strike a careful balance between regulatory compliance and seamless usability.

Another critical factor is AI governance and compliance. With healthcare’s stringent regulations, it’s essential to build in controls for responsible AI at the experimentation phase. Establishing these controls ensures the organization stays aligned with ethical AI principles, mitigating risks associated with bias, member trust, and legal exposure.

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Looking Ahead: AI as a Catalyst for Workforce Evolution

AI’s role in healthcare is not just about cost savings or efficiency; it’s about redefining the value of human roles within the workforce. As AI handles more administrative and transactional tasks, the focus for care managers shifts to higher-level functions, including health advocacy, emotional intelligence, and cognitive issue resolution. The roles of today will evolve, with new positions like AI Prompt Engineers and AI Knowledge Engineers becoming critical in an AI-augmented workforce.

Ultimately, AI offers the potential to empower care managers, and enhance the member experience. By harmonizing people and technology, healthcare payers can unlock new opportunities for growth, better health outcomes, and a more engaged workforce. AI is more than a tool; it is a strategy that, when deployed effectively, can sharpen a payer’s competitive edge and drive real, measurable results.

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