The AI Transformation of Health Plans: Call Centers, Prior Auth, and ROI That Actually Makes Sense
Health plans are sitting on one of the clearest AI opportunities in all of healthcare. The call center alone carries 40% annual turnover. Prior auth is drowning clinicians in paperwork. And ROI models are still stuck in the past. This session cuts through the noise. In this Track 5 session from Context 2026, Nagesh Rao, Managing Director at Innovaccer, leads a grounded conversation with Marv Richardson, Board Member and former CIO at HCSC; and Paul Juan, Chief Operating Officer at Personify Health, on where health plan AI is actually delivering today, how to think about vendor selection in a market moving faster than anyone can track, and what transformation really looks like for large payer organizations. In this video: → Where health plans are on the AI maturity curve today → Why the call center is the clearest early win for AI at scale → How voice AI agents are already handling member calls at major Blues plans → The right way to think about ROI — and why token costs are the new budget crisis → AI as a productivity tool versus a transformation platform — and how to sequence both → How to select AI vendors without wasting six months on the wrong evaluation Chapters: 00:00 Introductions and the AI hype cycle in healthcare 02:31 Where health plans sit on the AI maturity curve 04:13 Moving from AI as a personal assistant to operational transformation 06:04 Why scaling AI is so hard in a regulated payer environment 07:40 Where AI is actually scaling — the call center opportunity 09:01 Why members often prefer AI over talking to a human 10:14 Challenging assumptions about member preferences and AI adoption 11:49 The human-AI balance — what AI should do and what humans should keep 13:15 The tire pressure analogy — context, AI, and when to step in 14:37 Prior authorization — AI is great for a yes, not for a no 16:22 How AI agents should prepare clinical documentation for clinician review 17:52 Vendor selection — how to choose without overspending on evaluation 21:06 Crawl, walk, run — enterprise versus point solution deployment 22:37 Productivity tool or transformation platform — how to think about both 26:04 ROI on AI — real cost removal versus cost-plus models 28:22 Token budgets — the cost problem nobody has solved yet 29:02 Is AI a toy or a tool — why it matters for adoption and ROI 32:05 Building trust in AI — employees, members, and the house divided 33:18 Giving employees early access to build confidence and adoption 🔗 Watch more Context 2026 sessions: https://lnkd.in/gsNS-ytr