04: Shaping Care
How we reduce healthcare costs and improve outcomes by nudging everyone towards the best care.
7 AI use casesGuide Providers
Engage and support our providers to help them keep our members’ healthcare on track.
Equip Providers With Data, Tools & Insights
Let providers use our data, care management and engagement tools and insights to drive outcomes like better referrals, care reminders and affordability.
Guide On Benefits & Financials
Give providers cost estimates and other relevant information.
Engage Providers
Engage our providers in our digital channels, inbound and outbound campaigns to have their attention in the moments that matter for the member.
Engage Members
Convince members to start their care with Oscar.
Generate Digital Engagement
Earn and keep our members’ attention through all digital channels, in the moments that matter for their health.
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Status: Pilot / Prototype
We spend a lot of time thinking about ways to proactively engage members—on everything from way so to improve health to tips on how to get the most out of their coverage. We already use GPT as an ideation tool for campaign concepts and content, and are exploring ways to integrate this functionality more directly campaign creation workflows, for example, by generating email copy variations programatically.
Explain Healthcare
Eliminate confusion and errors when members navigate healthcare.
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Status: Idea / Exploration
Healthcare is full of jargon and we’ve always made a point of explaining healthcare esoterica in terms anyone can understand. To that end, we’re exploring allowing members and other users to mouse over a word or phrase in one of our apps to get a conversational explanation of any healthcare concept.
Enable Engagement Through/For Partners
Enlist the help of others in the healthcare system, like our providers and brokers, to engage our members with us.
Provide Culturally Competent Care
Get our members to providers and healthcare that’s uniquely personal and helpful.
Provide Excellent Member Service
Solve our members’ issues quickly, helpfully and profoundly.
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Status: Pilot / Prototype
Similar to providers, when members call us with questions, our top priority is helping them to get answers quickly. After each call, our care guides spend time typing up notes for their interactions that can be reviewed later both for quality improvement purposes and as part of the member’s profile. This last step is a great candidate for automation through a combo of automated transcription and LLM-powered summarization—our prototyping has confirmed that this is a viable and valuable use case.
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Status: Pilot / Prototype
While we believe strongly in the inherent humanity of healthcare, we also believe that technology can give our members the best of both worlds—instant answers for common questions, high touch navigation from care guides for the thornier ones. We’re investing in a range of capabilities that will allow us to automate voice and messaging interactions to provide faster answers when relevant and desired.
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Status: Pilot / Prototype
We survey members on member satisfaction and agent satisfaction after interactions. We can use LLMs to automate those ratings. We get member ratings for around 10% of our interactions. LLMs enable us to produce them automatically for 100% of our interactions. The write-up is here.
Encourage & Guide Members
Use incentives and rewards to influence and invest in our members’ long-term healthcare outcomes.
Invest In Members For The Long-term
Deepen our brand loyalty and earn members’ trust so that we can align alongside them when their long-term outcomes improve.
Deploy Rewards And Incentives
Use incentives and rewards to influence and invest in our members’ long-term healthcare outcomes.
Influence Utilization
Keep members on track in their healthcare journey by routing their care and managing their care journeys.
Route Care
When members need care, route their choice of provider.
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Status: Idea / Exploration
There are many potential applications of LLMs in search. One example we’ve experimented with is using a conversational interface to help translate a set of symptoms or health issues (as articulated by the member) into a structured set of clinically appropriate doctors for them to make an appointment with.
Enable Partners To Manage Care Journeys
When members receive care, help partners such as providers with our technology to remind them of the next best step.
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Status: Pilot / Prototype
One of the most important elements of managing a patient’s care is timely and relevant tips and guidance to help them manage their conditions. But providers often struggle to find the time to do this proactively. LLMs can help by generating first drafts of condition management suggestions to be reviewed and edited by the clinician, improving the scalability of value-based care.
Manage Care Journeys
When members receive care, remind them of the next best step.