Results

We built the fix before the market demanded it

We solved for cost. The growth was the surprise.

40% ROI in 6 months·40–60% lower admin cost·$12–18 PMPM recovered·500k+ lives

The pressure isn’t new. The answer is.

Unprecedented operational friction exists, but it has been rising for decades in healthcare. The current reported metrics are not new to what we’ve confronted inside health plans — and they’re why we believe intelligent automation is no longer optional. The difference is that now there’s a legitimate way to address the problem. Simultaneously, the problem is only getting more demanding.

What plans tell us

You didn’t need a market report to tell you operations were breaking. You’ve felt it for years.

Exhibit 01 · Market pressure
Health plan operations · 2026
Macroeconomic factor Current market metric Key drivers
Administrative cost inflation15–20% increaseWage growth for clinical staff, premium processing overhead, and mounting regulatory tracking.
EBITDA margin compressionTight 3–5% rangeSurging utilization, lowered federal risk-adjustment payouts, and elevated Medical Loss Ratios (MLRs).
Care manager turnoverExceeds 25% annuallySevere clinical burnout, competing provider staffing shortages, and poaching.
The 200k scaling wallOperational collapseFragmented manual workflows fail catastrophically when scaling past 50,000 members.

Figures reflect prevailing conditions reported across health plan operations. CareInsight outcomes on the following pages are measured from customer deployments.

Now it’s the recommendation. In 2023 it was our roadmap.

The industry now prescribes what we’ve been writing solutions to all along — automate every repetitive, non-clinical operational workflow that does not require human fiscal, clinical, or member-relations judgment, and reinvest those savings into high-touch member care.

That’s exactly what we set out to do — and succeeded with — in 2023.

Decouple growth from headcountTraditional utilization management and claims routing scale linearly, forcing plans to hire more staff. CareInsight breaks this cycle.
Protect clinical staffBy passing documentation assembly, data entry, and compliance tracking to AI agents, your clinical care managers focus entirely on medical-necessity reviews.
Rapid, non-disruptive adoptionRather than a risky “lift-and-shift” overhaul, CareInsight integrates natively within your plan’s existing legacy platforms, at your own pace.

But the results have gone well beyond the expectations and purpose of the solutions.

Recover $12–18 PMPM by automating manual work.

See how much you can save by eliminating administrative friction.

32→68% Member engagement
more than doubled carewallet.ai →
70% Less chart-review time
on one longitudinal record health3d.ai →
<5 min To build a care plan
down from 60–90 minutes ICP Agent · Care Management →
95% Of intake automated
any channel, case open in 2 minutes Intake Agent →

No rush to market. No stone unturned. No member left behind.

The full picture, by customer, by platform, and by workflow:

As insiders, we built the fix before the market demanded it.