Across healthcare, there’s growing recognition that the future of care requires not just more hands, but smarter support. Teams are under pressure to do more with less, while still delivering personalized, timely, and equitable care. The question isn’t whether AI can help—it’s how.
That’s where Agentic AI comes in.
Unlike traditional systems that rely on static rules or rigid workflows, Agentic AI is built to understand, adapt, and act. It’s designed to serve as a truly intelligent collaborator—one that augments human decision-making and improves the overall experience for both staff and members.
From Automation to Agency: A New Era of AI
We’re entering a new phase of applied AI—moving beyond automation into what we call agentic intelligence. This is where AI systems aren’t just responsive, but proactive. They don’t wait for step-by-step instructions; they recognize patterns, anticipate needs, and offer meaningful support in real time.
In healthcare, that kind of intelligence isn’t just nice to have—it’s critical. From resolving denied claims to helping members close care gaps, agentic systems can reduce friction, free up valuable time, and improve consistency across complex processes.
What sets agentic AI apart?
- Context awareness – It sees the full picture, not just isolated data points
- Initiative – It identifies issues and opportunities before they escalate
- Collaboration – It works alongside people, not in place of them
Reimagining Routine Workflows with Intelligence
Take the example of a denied claim grievance—a task many health plan teams are all too familiar with. It often involves sifting through documentation, interpreting policy nuances, and coordinating with multiple departments. Time-consuming, error-prone, and rarely satisfying for the member.
Now imagine an AI system that can:
- Instantly review benefits and coverage history
- Pinpoint where a claim went off course
- Collect supporting information
- Draft a resolution and route it to the appropriate team
What used to take hours—or days—can now be handled in minutes. But more importantly, teams are free to focus on higher-level work, and members get the timely answers they need.
Supporting Better Outcomes, One Member at a Time
As healthcare organizations work to improve quality ratings and close persistent care gaps, agentic AI can quietly play a transformative role. By continuously analyzing member data, it can surface timely, actionable insights—identifying who needs outreach, why they might be hard to reach, and what the most effective next step could be.
That might look like:
- Notifying a care coordinator when a member is overdue for an A1C screening
- Highlighting a transportation barrier that’s gone unaddressed
- Drafting a personalized message and scheduling follow-up
- Even arranging logistics like appointment booking or rides
With Agentic systems, this level of care and attention isn’t limited to a small group, it can be available for every member. This kind of support helps ensure that no member is overlooked—and that care becomes more accessible, more equitable, and more human.
Responsible by Design: AI That Aligns with Human Values
In any discussion about AI, ethics must take center stage. Agentic AI is not just about what technology can do—it’s about what it should do, and how it fits into a system built on trust and care.
That means:
- Designing for fairness, so that biases are identified and addressed
- Prioritizing transparency, so that both staff and members understand how AI is being used
- Preserving human agency, so decisions always remain in the hands of people
AI should reflect the values of the organization it serves. Done right, it strengthens—not replaces—the human connection.
Looking Ahead
Agentic AI isn’t a silver bullet, and it isn’t a standalone solution. It’s part of a broader evolution in how healthcare organizations think about technology, teamwork, and trust. The promise lies not just in what AI can automate, but in what it can amplify—judgment, compassion, efficiency, and care.
As this field continues to mature, the most successful organizations will be those that embrace AI thoughtfully, iteratively, and ethically—using it to enhance the work of people, not sideline it.
We’re excited to be part of that journey.
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If you want to explore what Lilac is doing with Agentic AI and how we can help you drive greater scale and impact across your plan, start a conversation by reaching out to us via the form in this link.
