AI Agents For Health Plans

Skypoint AI agents help payors automate utilization management, close care gaps, improve quality scores, and reduce costs across value-based care programs.

Who We Work With:

Achieve 400% ROI with AI Agents

Skypoint AI agents are purpose-built to streamline payer operations, automating critical processes such as prior authorizations, utilization management (UM), quality reporting, and risk adjustment. This reduces administrative burden and enables teams to focus on delivering measurable outcomes.

The platform unifies claims, clinical, pharmacy, and SDOH data through modular, intelligent agents. Leveraging automation and computer vision, these agents eliminate manual work, deliver actionable insights, and help close care gaps across populations.

By optimizing workflows and improving data accuracy, Skypoint empowers payers to achieve up to 400% ROI—improving quality scores, boosting member engagement, reducing costs, and maximizing value.

Unified Data Platform (UDP)

Payor Data Sources

EHRs, DMEs, Claims, CRM, Labs, Pharmacy, SDOH & more.

Unify All Data Sources

EHRs, DMEs, Claims, CRM, Labs, Pharmacy, SDoH and other system data you use regularly.

Policies & Regulations

Internal policies, regulations, procedures, and other documentation.

All Unstructured Data

Unify all your unstructured data that include policies, procedures, and any other internal documentation.

AI Agent and Applications

General Knowledge Agent

Enables teams to ask questions in natural language and get instant answers from unified data, policies, and documents—no analysts needed.

Risk Adjustment Agent

Improves coding accuracy and documentation to ensure proper risk scoring and optimized revenue under value-based care models.

Quality Measure Agent

Monitors and improves STAR ratings, HEDIS, and ACO metrics—automating compliance tracking and driving quality performance.

Utilization Management Agent

Automate prior authorizations, accelerate reviews, and improve care decision accuracy with intelligent, real-time insights.

Care Gap Closure Agent

Identifies and closes open care gaps across populations to improve member outcomes and contractual performance.

Member Engagement Agent

Personalizes outreach based on demographics, claims, and past interactions to drive preventive care and satisfaction.

Cost Intelligence Agent

Analyzes spend patterns, utilization trends, and care episodes to uncover high-cost drivers and optimize total cost of care.

Resource Allocation Agent

Improves care team efficiency by aligning staffing and services to member risk, utilization, and predicted needs.

Patient Outcome Forecasting Agent

Predicts outcomes for member cohorts using historical and real-time data to guide care strategy and benefits design.

Transform Health Plans with the Skypoint AI Agents

AI agents purpose-built for payors to automate workflows, reduce costs, close care gaps, and improve outcomes across Medicare Advantage, ACOs, and value-based care.

Industries We Serve

Apps

The Skypoint AI Platform

Data and AI Resources

Training and Events

Resources

Who We Are

About Skypoint

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