How AI can help care management programs to scale

With healthcare costs continuing to soar, it's become one of the top three major operating concerns for businesses big and small, HR departments and self-insured employers.

In a recent survey of chief financial officers (CFOs) from 161 organizations by consulting firm Mercer, the average health benefit cost per employee is expected to top $18,500 in 2026. As employers and health plans look for ways to control costs without reducing access or quality, care management has become more important, but also harder to scale.

Contributing to the rising cost: expensive new treatments (66%), an aging workforce (57%), healthcare system consolidation (53%), GLP-1 drugs (47%) and funding cuts (46%). Furthermore, only one in four CFOs said they were able to absorb benefit cost increases without impacting business over the past two years.

Traditional care management models are part of the solution, but many were not designed to scale efficiently in today's cost and labor environment.

Many traditional care management programs depend on repeated outreach, education, eligibility checks, enrollment support, follow-up, and coordination across systems — all of which require time, staffing, and consistency. With healthcare still struggling with staffing shortages, clinical AI, especially AI voice agents, can help. When deployed thoughtfully, AI voice agents can expand capacity by automating routine outreach, intake, reminders, and follow-up while escalating more complex or sensitive needs to human teams. The best deployments do not begin with the question, "Where can we use AI?" They begin with, "Where are patients getting stuck, where are teams overloaded, and where is the current process failing to scale?"

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Scaling clinical AI with purpose

It seems everyone in healthcare is touting the wonders of clinical AI. While it is not a solution for all of healthcare's woes, it can help TCMs when deployed strategically. Start by taking inventory of where goals are not being met. Is it taking too long to onboard new patients? Are administrative demands taking away from patient care? Is there just not enough staff and clinicians to meet patient needs? Are patients and staff being met where they are, both emotionally and in practice? 

In one real-world example, a metabolic health management company currently has a 13-step onboarding process for new patients that involves medical eligibility requirements and coordination. The call often requires device compatibility checks and integration of disparate systems, delaying and in some cases hindering patient care. An emotionally intelligent AI voice agent is now being used to automate and standardize the process, from insurance verification to hardware compatibility. 

By deploying a tailored AI voice agent, the company increased call completion rates from 51% to 85%, meaning more patients were able to complete the required onboarding steps without additional manual outreach.

Voice agents can also extend access beyond traditional business hours, allowing patients to begin administrative and intake steps when it is convenient for them, while preserving clinician time for higher-value care. By automating part of the patient experience beyond the 9-to-5 work window, a personalized AI voice agent can increase patient volume without the need to add more staff and free up clinicians to focus on patient care during working hours. In turn, patients can start the process and receive care at a time that works for them. 

The results speak for themselves in another real-world case: A telehealth-based specialty clinic saw a 40% increase in intake volume during the 7 pm-midnight hours and 550 hours redirected to metabolic coaching when they added an AI voice agent to their workflow.

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Improve patient outcomes cost-effectively

AI voice agents will ultimately lead to cost efficiencies. The telehealth specialty clinic mentioned above saw a $22.50 savings per patient intake when it once cost $41/per hour when handled by a human administrator, who could be redeployed for more essential tasks.

Not all AI voice agents are created equal. Healthcare organizations should evaluate whether the agent is transparent about being a virtual agent, whether it follows clinically reviewed scripts and guardrails, whether it knows when to escalate to a human, and whether its tone and pacing are appropriate for patients who may be anxious, confused, or overwhelmed.

With healthcare costs taking more and more of the benefits pie, health programs must find innovative ways to scale efficiently without adversely affecting the patient experience and care. Clinical AI, especially voice agents that can be tailored to specific business needs, can be effective tools to help health programs stay on firm financial footing while expanding reach and impact. Healthier employees boost morale, productivity and profitability. 

The future of care management will not be human-only or AI-only. It will be a hybrid model where AI expands reach, standardizes routine engagement, and gives clinical teams more time to focus on the patients who need them most.