Stars are not decided at survey time. They are decided on the last call.
Real-time AI assist across every member and provider interaction, built into the platforms your team already runs.
12 of Top 15
US health plans
3 of Top 5
Blue (BCBS) plans
100M
lives touched across the value chain
Avasant RadarView™
Leader in Healthcare Payer Business Process Transformation
Everest Group PEAK Matrix®
Leader in Healthcare Payer Intelligent Operations
NelsonHall NEAT
Leader in Healthcare Payer Agility & Innovation
Everest Group
Front-runner in the Generative AI Healthcare Payer Market
NelsonHall
Leader in Healthcare Payer Operational Transformation
ISG Provider Lens™
Leader in Payer Transformation on Healthcare Digital Services
Everest Group PEAK Matrix®
Leader in Healthcare Payer Business Process as a Service Solutions (BPaaS)
WHY THIS MATTERS
What’s eroding member trust, and plan revenue
The gap between what members experience and what plans believe they experience is where retention leaks.
Trust gap
~25 pts
Health plan leaders say 76% of members see them as true partners in care, but only 51% of members agree. That 25-point gap shows up in loyalty and retention.
HealthEdge 2025 Consumer Survey and 2026 Annual Payer Report
Switching risk
27%
of consumers say they’re likely to switch plans this year, driven by poor experience, weak self-service, and unresolved care gaps.
HealthEdge 2026 Annual Payer Report
Quality gap
~20 pts
Top-quartile plans outperform bottom-quartile plans by roughly 20 points on key HEDIS measures, underscoring the gap between outreach quality and closing care gaps before the deadline.
NCQA State of Health Care Quality Report
PROVEN OUTCOMES
What two live agents actually move on the member journey
Live outcomes from member engagement programs across multiple US health plans.
700K+
members reached
Proactive gap-in-care outreach reached more than 700,000 members across multiple plans, at a 50% to 70% engagement rate.
12%
higher HRA closure
Digital health risk assessment outreach across multiple languages lifted HRA closure rates by 12%.
30%
routine volume deflected
Self-service and digital channels now absorb about 30% of routine member volume, freeing agents for complex cases.
$4.3M
realized in member outreach
Visit-adherence outreach converted missed appointments into $3.1M in recovered revenue and $1.2M in operational cost savings for a major health plan.
Member engagement Solutions
Where the journey runs, and where the agents already are
Five stages across the member journey. Two AI agents in production across all of them. Inside your existing platforms.
Gaps closed before members notice them
Proactive omnichannel outreach identifies at-risk members, prioritizes by clinical risk and HEDIS deadline, and tracks closure back into reporting, not a send-and-forget campaign.
- 700K+ members reached
- 50-70% engagement, multilingual
From reminder to confirmed care
The care navigation AI agent connects members to in-network providers, handles scheduling, resolves transportation, and confirms appointment completion.
- Addresses SDOH and language barriers in routing
- Appointment outcomes fed into risk stratification
Resolved inside the CMS window
We run AI-assisted intake, categorization, and routing, with pre-summarized case context for clinical reviewers, tracked against NCQA and CMS benchmarks.
- 66% turnaround reduction
- 99.5% urgent within 4 hours
- 99.99% decision accuracy
Every agent interaction, faster
The member engagement AI agent handles eligibility, claims status, authorization, and billing before the agent queue, routing complex cases to specialists with full context pre-loaded.
- 12M+ provider and member interactions a year
- 20% lower handle time
- 30% deflection to self-service
Benefits members actually understand
AI-generated, health-literacy-appropriate education across benefit navigation, disease management, and preventive care, sequenced alongside care-gap outreach.
- Health-literacy-appropriate content across languages
- Sequenced alongside gap-in-care campaigns
- Outcomes fed into care management
WHO WE SERVE
Your plan type determines where members disengage
Member trust breaks at different points across national plans, Blues, self-funded, and specialty. We build the engagement model for yours.
National plans
Scale without losing the member conversation
National plans need member engagement at scale across Medicare, Medicaid, Commercial, and Exchange. Firstsource runs 16,000-plus member experience specialists behind every program, with outcomes in the contract.
Blues plans
A&G triage built for high-volume Blues books
Blues plans carry high A&G volume with strict regulatory timelines. Firstsource runs appeals triage built for high-volume, deadline-sensitive books, sorting urgent from standard and clearing backlogs without compliance exposure.
Self-funded
Employee engagement drives benefit utilization
Self-funded employers need members to engage with benefits to reduce downstream claims cost. Firstsource runs multilingual, multichannel outreach programs that move benefit utilization and care-gap closure rates.
PROOF OF DELIVERY
Live engagement programs, each proving a different result
Handle time reduction, A&G accuracy, and outreach reach. Each from a different live engagement.
40%
more booked visits
A member outreach and scheduling program reduced no-shows by 66% and increased booked across 30+ specialties.
45%
prior auth cost reduction
Intake hub cut prior authorization operating costs by 45% for a mid-size regional Medicare and Medicaid plan.
12%
HRA closure rate improved
A tech-first, multichannel HRA program improved closure rates by 12% and reduced delivery cost by 25% for a regional Medicaid plan.
INSIGHTS
Latest from the Firstsource team
Insights from the field, real operations, real outcomes, and perspectives from the people making it work in live operations.
Case Study
Building a strong foundation for growth: how a leading dental plan transformed operations with strategic partnership
Discover how a leading dental plan partnered with Firstsource to transform operations, reduce costs, improve CSAT, and enable scalable growth through AI and a hybrid delivery model.
contact us
Member trust is won at the touchpoint. Or lost there.
Where members drop off depends on your plan type and line of business. That is where the program starts.
- Live AI agents across outreach, navigation, appeals, and services.
- Priced on engagement, care-gap closure, and A&G turnaround.
- 16,000+ member experience experts behind every program.