PhilCare leads on AI-enabled health insurance with Proto’s AICX Platform

PhilCare relied on patient support via hotline and email, but the growing number of incoming patient requests sometimes reached thousands per month – which was difficult for human agents to handle alone. Most requests were simple questions, such as inquiries about doctor affiliations and hospital accreditations. However, with only 10-15 agents, this resulted in long wait times and low patient satisfaction, posing a risk to PhilCare's membership renewal rates.

In order to address this challenge, PhilCare was looking to automate their contact centre with a solution that could handle large volumes of patient queries with speed and accuracy. Given PhilCare's diverse patient base, the solution would also need to be able to handle inquiries in English, Cebuano, Tagalog, and mixed languages, such as Taglish (a mix of English and Tagalog).

PhilCare evaluated a few solutions and vendors. After a one-month trial, Proto's AICX Platform surpassed PhilCare's expectations – reducing patient query resolutions to 2 seconds and human agent reliance to 52%. Since its deployment, the platform has responded to over 2.6M messages, with superior intent classification in Tagalog and Taglish to serve its local customer base.

The chatbot (Phil) was deployed on PhilCare's website and Facebook Messenger, allowing 400,000+ patients all over the Philippines to receive instant responses to frequently asked queries instead of waiting for responses over the phone or via email.

Phil is integrated into PhilCare's internal systems to answer requests such as:

• Checking accredited hospitals and clinics
• Checking affiliated physicians
• Finding out about plan coverage
• Claiming reimbursements
• Generating letters of authorization for online or face-to-face consultations

In the coming months, the platform will be expanded and trained based on Proto proAnalytics to find out what other inquiries can be automated and answered by Phil, ensuring continuous improvement.

PhilCare CTO Charles Alexis Aquino said: “PhilCare leverages technology to deliver exceptional service to our clients. We believe that strategic partnerships like the one we have with Proto will help us achieve our goals. In just the first few months of using Proto's platform, PhilCare immediately felt an improvement in delivering our services. Thank you to the competent team from Proto!”

With Proto's cutting-edge AI solutions and API integrations, PhilCare was able to address the challenges of their patient support operations. Patients have convenient and accessible healthcare services, improving overall healthcare membership satisfaction and reducing the risk of losing patients due to long wait times or lack of response.

The implementation of Proto's AICX solution is part of PhilCare's strategy to ensure world-class healthcare services for its Filipino clients while leveraging innovative solutions. Proto is proud to assist PhilCare in its mission of making wellness more efficient and accessible for everyone through technology.