Microsoft Scenario Library Healthcare Payor – Curate member education materials

Available with: Microsoft 365 Copilot and Copilot Studio

Healthcare scenario: Payor – Curate member education materials

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Scenario

Provide better educational materials to assist with prevention efforts

1. Analyze member information

Have a Copilot agent to gather and analyze member’s health record, demographic information, coverage policies, and associated guidelines to understand member preferences and needs.

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Copilot Studio Agent

Benefit: Provides a comprehensive analysis of member data to understand the pain-points, thus empowering care mangers  by providing relevant member insights.

Use Copilot Business Chat to generate questions that an outreach coordinator can use to engage with targeted member groups.

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Microsoft 365 Copilot Chat2

Benefit: Facilitates meaningful interactions by providing tailored questions that incentivize member engagement.

Use a Copilot agent to generate and share personalized reminders for preventive care visits, screenings, vaccinations, medication refills, and adherence.

Copilot Studio icon

Copilot Studio Agent

Benefit: Ensures members receive timely and personalized reminders, improving adherence to preventive care schedules and therapies.

Use a Copilot agent to analyze information from Medicare, Medicaid, or commercial policy coverage and other member-provided information to identify social determinants of health (SDOH) recommendations for members.

Copilot Studio icon

Copilot Studio Agent

Benefit: Reduces burden on care manager by providing detailed insights derived through a comprehensive analysis on SDOH.

Use a Copilot agent to assist managers in generating personalized educational content for members based on analyzed data.

Copilot Studio icon

Copilot Studio Agent

Benefit: Assist care managers in generating personalized educational content.

KPIs

Opportunity to impact key functional area KPIs

How Microsoft Copilot can help improve product time to market

The time spent on drug research and trials. Reducing time to market can reduce costs and accelerate revenues.
Boost productivity
  • Rapidly find information
  • Diagnose problems faster
  • Check for similar issues and resolutions
  • Quickly send follow-up communications

How Copilot can help to reduce claims processing time

This KPI measures the average time to process a claim and can impact patient satisfaction.
Respond to a claim
  • Create richer, faster responses to claims
  • Have Copilot assist with drafting and summarizing emails
  • Simplify finding information for claims responses

How Copilot can help to reduce wait times

This measures the average time a patient waits before receiving care. It’s calculated by dividing the total wait time by the number of patients.
Reduce waiting
  • Address more queries in less time
  • Personalize solutions
  • Improve staff availability based on automated capacity-based scheduling
  • Diagnose problems faster

How Copilot can help to reduce readmission rates

This measures the percentage of patients who are readmitted to the hospital within a specific time frame after being discharged.
Reduce churn
  • Address more queries in less time
  • Personalize solutions
  • Improve staff availability based on automated capacity-based scheduling
  • Diagnose problems faster

How can Copilot improve patient retention

This KPI measures the percentage of patients who return to the same healthcare facility for future care.
Reduce churn
  • Address more queries in less time
  • Personalize solutions
  • Improve staff availability based on automated capacity-based scheduling
  • Diagnose problems faster

The content in this example scenario is for demonstration purposes only. You should evaluate how Copilot aligns with your organization’s business processes, regulatory requirements, and responsible AI principles.