In our previous articles, we’ve covered the gap between insights and action, and how agentic AI systems can bridge that gap. Now let’s discuss how health plans can practically approach implementing these systems and why early movers will have a significant competitive advantage.
Starting Your Agentic AI Journey
The key to successful agentic AI deployment is beginning with focused, achievable initiatives that show measurable impact. Rather than starting off by trying to automate the largest and most cumbersome part of an operation, Lilac has seen successful plans focus on specific use cases where the ROI is clear and the workflows are well defined.
Start with High-Volume, Low-Complexity Workflows: Begin with processes that happen frequently and don’t require complex decision making. Medication adherence reminders, preventive care outreach, and routine follow ups are ideal starting points.
Choose Areas with Clear Success Metrics: Focus on workflows where you can easily measure improvement. If it takes your team 3 weeks to deploy an intervention today, and the agentic system can do it in 3 hours, that’s a clear win.
Build on Existing Data Infrastructure: Agentic AI systems work best when they have access to clean, comprehensive data. If you’ve already invested in data aggregation and normalization (like what we provide at Lilac), you’re well-positioned to add agentic capabilities on top.
Implementation Best Practices
Phase 1: Automate the Orchestration, Not the Strategy: Start by automating the manual steps that happen after decisions are made, not the decision-making itself. Let humans define which members need outreach, then let the agentic system handle the segmentation, personalization, and delivery.
Phase 2: Expand Decision-Making Authority: As you build confidence in the system, gradually expand the types of decisions it can make autonomously. This might include prioritizing intervention strategies or adapting communication methods based on member response patterns.
Phase 3: Cross-Functional Integration: Once individual workflows are automated, begin connecting them. An agentic system that can coordinate between quality management, cost management, and member retention creates much more value than isolated automations.
The Strategic Advantage for Early Adopters
The competitive implications of agentic AI are significant. Plans that effectively deploy these systems will be able to:
Deliver More Personalized Member Experiences: When interventions happen immediately and are tailored to individual member preferences and barriers, satisfaction and outcomes improve dramatically.
Achieve Better Clinical Outcomes: Faster response times and more consistent follow through lead to better preventive care completion and chronic disease management.
Operate with Lower Administrative Costs: Automating complex workflows reduces the labor required for routine operations while improving quality and consistency.
Scale Without Proportional Cost Increases: Agentic systems can handle growing member populations and expanding service offerings without requiring proportional increases in staff.
Looking Ahead: The Future of Health Plan Operations
The plans that embrace agentic AI today will define what successful health plan management looks like tomorrow. While competitors are still manually processing intervention lists and struggling with delayed responses, agentic-enabled plans will be operating with speed, precision, and scale that creates insurmountable competitive advantages.
This isn’t about replacing human expertise—it’s about amplifying it. The most successful implementations we’ve seen combine the strategic thinking and empathy of skilled healthcare professionals with the speed and consistency of intelligent automation.
Building vs. Buying
Most health plans will find that building agentic AI capabilities from scratch is neither practical nor advisable. The complexity of healthcare data, regulatory requirements, and the specialized AI models required make this a significant undertaking.
The more practical approach is partnering with technology vendors who are specifically building these capabilities for healthcare. Look for partners who understand both the technical requirements and the operational realities of health plan management.
The question isn’t whether agentic AI will transform health plan operations – it’s which plans will lead the transformation and which will be left trying to catch up with outdated tools and manual processes.
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Lilac Software is building agentic AI capabilities into our platform to help health plans automate complex operational workflows. If you’re interested in learning how these systems can transform your plan’s operational efficiency, reach out here to start a conversation with the Lilac team.