At Kore.ai, we believe AI should reduce friction—not add to it. That’s especially true in healthcare, where legacy processes too often delay care, frustrate patients, and drain resources. I recently had the opportunity to speak with two leaders deeply invested in fixing that: Michael Duke, Lead Partner at Guidehouse, and Dr. Anthony Chang, pediatric cardiologist and Chief Intelligence and Innovation Officer at Children’s Hospital of Orange County (CHOC), and founder of the American Board of AI in Medicine.
Together, we explored how healthcare organizations are using conversational and agentic AI to not only optimize operations, but to fundamentally reimagine patient and member experiences.
The Hidden Cost of Financial Clearance
Guidehouse partners with a provider that was spending more than 30 minutes per call to verify insurance coverage, obtain pre-authorizations, and validate service locations—work typically handled over the phone with payer representatives.
The result? Escalating operational costs, staffing challenges, and avoidable write-offs from missed authorizations.
“Our people were doing their best, but the volume and complexity just didn’t scale,” Duke shared.
Automating the Problem—with Empathy
To tackle the issue, Guidehouse deployed a Kore.ai-powered voice-based assistant—a polite, persistent virtual agent capable of:
- Navigating complex IVRs
- Waiting on hold (often 20–45 minutes)
- Speaking with payer reps to retrieve coverage details
- Logging the results automatically
In early phases, the assistant handled 4,100+ calls, achieved an 85% success rate, and saved over 15,000 staff hours annually—without displacing a single employee.
“The reps didn’t even realize they were speaking with a bot,” Duke said. “Some even complimented its Southern-style politeness.”
To maintain scalability, Kore.ai will introduce multi-persona capabilities—giving the bot names like Mary, Emma, and Bob—and embedded generative AI to dynamically adapt to changing IVRs and carry out more natural conversations.
From Call Automation to Full Workflow Intelligence
Today, these assistants go far beyond the call. With Kore.ai’s AI for Process, they:
- Pre-orchestrate outreach strategies
- Capture structured data from conversations
- Auto-document results in EMRs
- Trigger downstream workflows without human input
This level of orchestration ensures compliance, reduces manual work, and accelerates time to resolution—freeing up clinical and administrative teams to focus on higher-value tasks.
AI’s Next Leap: From Insights to Autonomous Action
Dr. Anthony Chang offered a broader clinical lens on what’s next. He categorized the evolution of AI in healthcare as:
- Health AI 1.0 – Traditional machine and deep learning
- 2.0 – Generative + agentic AI (what he calls convolutional intelligence)
- 3.0 – Cognitive AI, featuring digital twins, autonomous agents, and true precision care
In one scenario, he described a pediatric discharge experience where generative AI translates instructions into Spanish, personalizes them for children, and creates engaging storybooks. Agentic AI then handles scheduling, medication logistics, transportation, and even alerts clinicians if a wearable signals risk.
“Generative AI provides insights. Agentic AI takes action,” he explained. “When combined, the impact is geometric—not just additive.”
What This Means for Healthcare Now
At Kore.ai, we’ve spent years developing enterprise-ready conversational AI Agents. Now, we’re expanding into clinical decision enablement and government-scale deployments—partnering with organizations like Guidehouse to improve access, reduce cost, and streamline operations for providers and payers alike.
What excites me most is how these systems are evolving to feel more human, even as they handle more complexity. With the right blend of technology and empathy, AI can be both scalable and supportive—making care more accessible, more responsive, and more personal.
Final Thoughts
Healthcare is under pressure from every direction. But with the right AI systems in place, we leap ahead. We can remove the delays, bottlenecks, and inefficiencies that get in the way of great care.
If you’re ready to explore how conversational and agentic AI can elevate your organization, let’s talk. The future of healthcare isn’t just coming—it’s already in motion.
