AI for better care: Enabling faster care coordination
UnitedHealthcare is using AI to help improve care coordination, with the goal of better outcomes and simpler health care experiences.
Artificial intelligence (AI) isn't replacing human care — it's helping make health care more connected, personalized and timely.
UnitedHealth Group — recently ranked by Fortune as No. 1 in Health Care on their “AIQ 50” list, which evaluates how companies are using AI1 — is applying AI across its UnitedHealthcare and Optum businesses to simplify how people find care and navigate the health system. The result: more timely coordination and simpler health care experiences.
Finding relevant care and support
Considering about half of insured adults surveyed reported difficulty understanding at least one aspect of their health insurance,2 UnitedHealthcare recognizes that it’s important to find ways to make health care easier to navigate.
When members have simple questions, they don’t want to have to spend ample time searching for the answers they seek. That’s why UnitedHealthcare introduced a generative chat messaging experience that summarizes benefits and coverage information and anticipates needs proactively — in a conversational style.
And when a member has a more complicated manner, the chat can connect them to a human Advocate who can help. Once on a call, an AI-powered assistant uses natural language processing to understand and identify their reason for calling and directs them to the most suitable resource, whether that's a self-service option or a live advocate.
When it comes to finding care, UnitedHealthcare members can leverage the Smart Choice provider search experience, which uses AI modeling to prioritize provider search results based on quality criteria, the member’s specific benefits and coverage, convenience to the member and personal preferences. This search experience aims to reduce the amount of time employees and their families spend sifting through all available care options and empower them to make more informed choices.
For employers, these AI-powered tools may translate to healthier and more satisfied workforces. When finding care and support feels as seamless as other daily experiences, employees may be more likely to address health concerns earlier and seek care from quality providers who may also be more cost-effective.
Coordinating care more efficiently
AI is also assisting Advocates in helping members navigate the health system by surfacing real-time, member-specific information directly on their screens based on claims activity or previous calls to the Advocate to streamline authentication and personalize support.
The AI technology also uses voice analytics to understand the member’s questions and provides benefits, coverage and cost answers from the member's benefit plan and summarizes the conversation so that Advocates can add the summary to the member’s file. That way, when a member calls back, the Advocate doesn’t have to spend a long time understanding the member’s call history.
With a focus on easing administrative burden for providers so they can focus on caring for their patients, UnitedHealth Group, UnitedHealthcare and Optum are collectively looking to streamline workflows. For instance, Optum is integrating ambient, conversational and generative AI to capture patient-provider conversations in real time and generate structured clinical summaries. This allows providers to spend less time typing and more time engaging with patients and coordinating their care.
Optum Real, which is powered by AI and automation, is facilitating the real-time exchange of patient visit, claim and payment data between providers and payers like UnitedHealthcare who buy this program. This gives providers greater insight into how payers will process a claim, enabling them to offer patients clearer answers into what's covered and what they'll owe as well as reducing the chance for care or a procedure to be denied or cancelled due to a processing or authorization delay or issue.
Launched in 2025, more than 4,000 providers have used this solution, which has saved them 2M minutes on documentation across 360,000 visits.4 A 43% cut in note-taking time creates space for providers to meet with more patients, spend more time in each visit and provide faster follow-ups and referrals.4
AI is also being used to help read and prioritize prescription refill requests, reducing the amount of time nurses spend intaking requests or outreaching to patients. In a 16-week pilot with 27 providers, more than 25,000 refills were processed efficiently, with 30% approved in one click.4
Streamlining time-consuming tasks and helping to ensure Advocates and providers have the information they need, when they need it, to be effective in their roles is working to deliver a more coordinated and efficient care experience to the members and patients they serve. For employers, that can lead employees to spend less time dealing with their care and more time focused and present at work.
Predicting care needs
Proactive care coordination starts with knowing what members need before they do. Predictive analytics using AI are helping UnitedHealthcare anticipate care gaps, flag preventive services due for renewal and provide members with information to enable more timely interventions.
For example, predictive models can flag when an employee with diabetes due for a routine checkup or when a member's prescription refill pattern suggests they may need additional support.
Here’s another example of how this works: Patient history and visit summaries are securely stored in a database, where AI analyzes the data to identify potential markers of undiagnosed conditions or increased disease risk. This includes high-risk members who were recently discharged from the emergency room or hospitalized. Clinicians and Advocates then review the AI predictions and recommendations, enabling more informed actions and timely interventions.
This collaborative approach between AI and member care teams has the potential to improve outcomes by facilitating early detection and targeted care.
AI is also being used to proactively serve up optional services or “care paths” to members that they may find relevant based on members like them with similar demographics and care journeys.
When used responsibly, AI holds great potential in helping make it easier for members to navigate the health system by enabling more timely and coordinated care and support.
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